Eight-month-old James King broke out in an infectious smile, and soon nurses and visitors in the pediatric neurosurgery clinic of Children’s Hospital of Georgia were smiling back and cooing over him.
Just above his grinning face, a large red “T” across the middle and top of his head marked where surgeons went in and placed springs to help his skull grow normally.
The procedure was far less invasive and bloody than surgery in years past to correct James’ condition, surgeons said.
James was born about 10 weeks premature, and his mother, Amanda, could tell something was different about him while he was in the neonatal intensive care unit.
“I started to notice that his head seemed to look flat on the side,” she said.
James had scaphocephaly, where the sagittal suture that runs down the middle of his skull and allows it to grow had fused too early. With growth occurring at other sutures, it was causing his head to become longer and narrower.
To correct these kinds of problems in the 1990s, surgeons used hand drills and chisels to break apart pieces of the skull and bend and reshape them in surgeries that might take eight hours and require blood transfusions.
Back then, Dr. Jack Yu, now the chief of plastic surgery at Georgia Regents University, pondered whether a spring inserted into the suture might not accomplish the same thing.
It now does.
Earlier this year, the Food and Drug Administration approved a new system of springs first developed in Sweden that can be placed in the sutures to apply the force needed to keep them from closing and help bones grow normally. Using specific measurements, the surgeon can select the exact amount of force to be applied.
“It is very precise,” Yu said. “Too much force, you’re going to split the bone. Too little force, it won’t work.”
The springs stay in four to six months and then must be removed, Yu said.
“You can’t take them out too early because the bone is not healed yet,” he said. “You can’t take them out too late because the bone will bury the spring.”
James got his procedure done in February and had them removed in June. That is one downside to the new procedure, said Dr. Ian M. Heger, the chief of pediatric neurosurgery at the Children’s Hospital of Georgia.
“The biggest drawback was the second operation, to put him through that,” Heger said.
But instead of hours on the table, the first procedure took about 45 minutes, Yu said. And there’s no need for a blood transfusion, Heger said.
“There’s really no risk of requiring a transfusion, which is a big deal in these little kids,” Heger said. There’s less trauma to the skull, less loss of bone, and the hospitalization is much less, he added.
“With this operation, when we as physicians get more comfortable, we’ll be sending kids home I think the next day after the surgery,” he said.
It is also less stressful on the parents, Amanda King said.
“I’ve heard stories from other people who have had the previous surgery, and it just seemed like he has had a much easier ride than some of the (previous patients),” she said. “To know that this one was going to be not so bad was very reassuring for us.”
The change after the surgery was immediately apparent, King said.
“As soon as they took off the bandages, I could already see a difference in the shape of his head,” she said. “And that just continued over the next few months.”
Heger got a big grin from James as he entered the exam room.
“The scars are healing up nicely,” he said as he examined the top of James’ head.
Because the scars are underneath the hair, they will not be readily visible and in the future people might not even know there was a problem, Yu said.
“We call that returning to a state of anonymity,” he said.
That is also an important part of the surgery, Heger said.
“In addition to doing the best work I can on the inside, I try and do the best work I can on the outside so it is not a constant reminder of what they’ve gone through,” he said.