Forging a head
Wellington doctors are pioneering a new surgical technique to help babies who are born with misshapen heads, a condition which affects about 60 Kiwi newborns a year. The operation can take under 45 minutes – but has lifechanging consequences for the patie
IT’S 1.03pm on a Thursday when surgeons slice a halfmoon from Mitchell Scales’ skull. It is done quickly. His scalp has been pulled back. A template is rested against his exposed bone, and a crescent shape marked out with, almost unbelievably, a regular pencil.
The saw cuts precisely. The bone is taken off, exposing the thin membrane around 15-month-old Mitchell’s young brain.
The toddler is motionless, the modern magic that is anaesthesia doing its trick. Reassuring beeps emit from the heart monitor. Now for the tricky part. Hutt Hospital plastic surgeon Charles Davis and neurosurgeon Agadha Wickremesekera must
‘‘It’s like Meccano for surgeons,’’ whispers nurse Alison Mackenzie, over the low pulse of the ventilator.
When babies are born, they usually have five separate bones in their skull to allow room for their brain and head to grow.
But one in every 2000 babies is born with one or more of these bones fused together.
It means that as they grow, their skull cannot expand. It is stuck together at the seams, and as the rest of the skull grows rapidly the head and face begin to twist, or bulge out.
In most people, the seams, known as cranial sutures, usually stay open until about 25 years old, to give the brain room to grow.
Mitchell had uni-coronial craniosynostosis, meaning the seams on the front left side of his skull were fused. When surgeons cut away Mitchell’s skull, they saw the pressure on his brain was immense.
As soon as they released it, the organ expanded like it was taking a breath.
At 2.29pm, Mr Davis gently fits Mitchell’s new skull.
By 2.50pm, he is stitching the muscle next to his eye.
‘‘Dad noticed [an odd head shape] very, very early on, at just a few weeks of age, and wondered if this was the condition and was assured by a few doctors that it wasn’t,’’ says Mr Davis, looping stitches through the wavy incision in Mitchell’s scalp.
‘‘His brain was really tight under the skull, and it was squashed down by his eye socket. He hadn’t shown any developmental problems, which is amazing when you think about it.’’
The whole left side of Mitchell’s forehead, which was sunken in, now looks even. It was brought forward by about 2 centimetres during the procedure.
Mitchell will be left with a mean looking scar, but his skull
Charles Davis, surgeon