What to Expect:
Craniosynostosis / Cranial Vault Remodeling
Before Surgery:
You will meet with your surgeon to discuss the details of the surgery and to have all of your questions answered in detail. A preoperative history and physical exam will be done, and you will be given an informed consent form to sign that gives us permission to do the surgery. You will also get detailed instructions for the preoperative and postoperative period, including wound care, and how to detect problems. Your baby will have to have an empty stomach before going to surgery, and you will be given specific instructions on when to stop feeding him/her. If your baby gets sick before surgery, you should notify us so that we can decide whether or not to proceed with the scheduled procedure.
You will also have an appointment this same day with the anesthesiologist in pre-operative clinic. At this appointment you will be instructed when to arrive the day of surgery and when your baby needs to stop eating and drinking before surgery. We encourage you to have the baby drink a lot the day before surgery and to wake them up early in the morning to give them something to drink until the time when oral intake should be stopped. It is more difficult to place IVs in babies who are dehydrated (from not drinking enough fluids). During this visit with the Pre-op Clinic you will also be instructed where to check-in on the day of surgery.
Pre-operative lab work will be drawn during this visit as well. We need to know your child's hematocrit and hemoglobin to make sure the baby is not anemic prior to surgery.
If you are traveling from a long distance and would like to stay at the Ronald McDonald house the night before, these arrangements can be made.
The Day of Surgery:
You will be instructed to arrive at the Surgery Center an hour or two before surgery. You will check in at registration on the first floor of the hospital. Once you are checked in, you will be taken to the pediatric holding area (you may be with your child in this area). When it is time for the baby to come down to the operating room, you will be instructed to bring the baby to the holding area of the operating room (again you will be allowed to be with your baby). The baby will be examined by the plastic surgeon, the neurosurgeon, and the anesthesiologist again, and this is a good opportunity to ask any last minute questions you may have. The baby will be given some oral medication to help make him/her sleepy. When it is time to go back to the operating room, the anesthesiologist will carry the baby back to the operating room and you will be shown how to obtain a pager so that we may be able to contact you during the case.
The baby will be put under anesthesia using a mask. Once he/she is asleep, the IV will be started and the baby will be intubated (the breathing tube will be inserted to breathe for the baby during surgery). The baby will also have an arterial line started in their wrist (this is for monitoring purposes during and after surgery). A catheter will be placed in your baby's bladder before surgery since it is a long procedure. The baby will be positioned on the table and prepared for surgery. Once the case starts, the nurse in the operating room will call out periodically to update you on the progress of the surgery. When surgery is almost complete, the nurse will call you to come to the waiting area to meet with your surgeon, who will discuss the surgery with you.
The baby will usually remain intubated (have the breathing tube in place) and will be taken down to the first floor (accompanied by the anesthesiologist and members of the surgeon's team) for another CT scan before being transferred up to the Pediatric Intensive Care Unit. Once the baby is settled in, you will be able to visit with your baby. Usually, the breathing tube will still be in place, and the baby will be sedated. Do not let this alarm you. If the baby does well overnight, the breathing tube will be removed the next morning and the baby will be allowed to be a little more awake. Your baby will have an incision on his/her head. The incision is kept open to air but will have bacitracin ointment on it; the nurses will apply the bacitracin ointment to the incision regularly. The baby will also have two drains coming out of the scalp, one on each side. This is to drain any excess fluid that the baby cannot initially absorb after surgery. These drains are attached to a bulb and the bulb is compressed to create suction and pull the fluid out of the baby's surgical site. The nurses will empty these drains at least every eight hours and more frequently if they need be. Once the drainage has slowed down considerably the drains will be removed (usually ~ 48 hours after surgery). The baby will also have arm restraints in place to make sure that he/she does not bother the surgical sites. These will come off once the baby is awake and alert.
The baby will remain in the PICU for a few days until they are stable enough to go to the pediatric ward.
In the Hospital:
One parent is allowed to stay with the baby during the hospitalization. There is a waiting room at the end of the hall of the pediatric ward which has chairs that convert into beds. The other parent is welcome to stay there and the parents may switch off during the course of the baby's stay.
Your baby will be visited each day by the plastic surgery team and the neurosurgery team. You will be given an update on your baby's condition each day. Please feel free to ask any questions during this time. You will also be visited daily by the pediatric plastic surgery nurse and the neurosurgery nurse who will ensure that you understand how to care for your baby once they are discharged. All of your questions will be answered, and you will receive detailed discharge instructions before you leave the hospital.
After Discharge until the First Postoperative Clinic Visit:
Your baby will be discharged with instructions to keep bacitracin ointment on the incision sites.
Your baby will be seen in the clinic for the first postoperative visit approximately one week after surgery. During this first week, he/she may not be quite normal; babies can be more fussy than usual or have disturbed sleep schedules.
When your baby comes to the clinic, the incisions will be examined and we will address any concerns you may have.
Subsequent Postoperative Visits:
The next postoperative visit occurs at three weeks after surgery. In most cases, after the three-week visit, we will see your baby again at six weeks postoperatively, then at three months postoperatively, and then every three months thereafter.