Q: Dr. Eppley, I have a long pointy head that is completely abnormal. It has looked this way since I was born. I have managed to get along in life and be a very productive person at 30 years of age. But I always wear a hat and never let anyone see me without it. My other brothers have completely normal head shapes. I would do anything to have a more normal head shape and live a more normal life. I know you have a lot of experience in reshaping of skulls, so I am very interested in your recommendations. I have attached pictures of me with a closely cropped haircut. Please help me.
A: Thank you for sending all of your pictures and describing your situation. I have great empathy for your head concerns. It appears you have a rather classic case of undiagnosed and untreated sagittal craniosynotosis. The AP cranial dimension is long, the transverse cranial dimension is narrow and there is frontal bossing which is wider than the occiput. This condition is rare to see in adults these days since almost all of them are treated as infants with the advent of widespread craniofacial surgery since the 1980s.
First, let me start off by saying what can’t be done. The traditional approach to sagittal craniosynostosis is complete cranial bone remodeling. But that can only be done in infants where the bone is very thin and pliable and one can work with the molding influence of the growing brain. As an adult, such a procedure can not be done as the bone is too thick and not pliable, the extent of surgery and the bleeding would have a high risk of significant complications, and there is not growth of the brain to fill the underlying dead space that is created.
While the bone can not be removed and reshaped, a camouflage skull reshaping approach can be done. This would consist of some burring reduction of the sagittal ridge and the frontal bossing and augmentation of the parasagittal skull and temporal regions. The combination of these reduction and augmentation procedures, while not making any shortening in the cranial AP dimension can give an improved appearance to the skull shape. I have attached some imaging which I think is achieveable.
To embark on this cranioplasty approach, good treatment planning is needed. This would consist of getting a 3-D craniofacial CT scan and then have an exact skull model made from it. It is off of this patient-specific skull model that the exact dimensional changes can be planned and the volume and shape of the needed implants fabricated.
Dr. Barry Eppley