Lambdoid Craniosynostosis (Posterior Plagiocephaly) in Bangalore

What Is Lambdoid Synostosis?

Lambdoid Craniosynostosis is a condition in which one of the soft joints at the back of the head (a lambdoid suture) fuses earlier than usual, so the back of the skull becomes slanted or twisted to one side — Posterior Plagiocephaly.

How It Affects Your Child

It produces an abnormally shaped head, slanted or twisted at the back. In very rare circumstances it can compress the brain and raise the pressure inside the skull. Because it is rare, it is sometimes confused with positional (deformational) Plagiocephaly.

How It Is Diagnosed

Your craniofacial surgeon will first examine your child thoroughly. A skull X-ray and a 3D CT scan of the head are usually needed; occasionally an MRI is also done to assess the brain.

How It Is Treated

Treatment is surgical and is carried out by a multidisciplinary team led by the craniofacial surgeon and neurosurgeon. Dr Vybhav Deraje leads the Craniosynostosis team at Aster Whitefield Hospital, Bangalore. The type of operation depends on your child's age.

Under 6 months of age: minimally invasive, endoscope-assisted keyhole surgery to remove the fused suture, followed by Orthotic Helmet Therapy. Above 6 months: an open operation called Cranial Vault Remodelling to reshape the skull.

Keyhole (Endoscopic) Surgery — What to Expect

Before surgery your child is assessed by a paediatric neuro-anaesthetist and has an eye check. Admission is on the day of surgery. The operation takes 1–2 hours under general anaesthesia. Because it needs only a small cut in the scalp, there are no major scars and no major blood loss, although a blood transfusion is occasionally needed.

Your child stays in the ICU overnight, where pain is well controlled by the critical care team, and normal feeding is encouraged. Your child moves to the ward the next day and usually goes home on the third day, after the head dressing is removed. You can give a normal head shower after that.

After Keyhole Surgery: Orthotic Helmet Therapy

After a check one week after the operation, Orthotic Helmet Therapy is started with the orthotic partner and continues until a good head shape is achieved; the helmet may need to be changed once or twice depending on progress. You will see the craniofacial surgeon and neurosurgeon at regular intervals.

Open Cranial Vault Remodelling — What to Expect

Before surgery your child is assessed by a paediatric neuro-anaesthetist and an ophthalmologist. Admission is on the day of surgery. The operation is done under general anaesthesia and usually takes 4–5 hours. Several monitoring lines (such as a central line and an arterial line) are placed, and almost all children need a blood transfusion during and after surgery.

The cut runs across the top of the head from one ear to the other. The neurosurgeon protects the brain while the craniofacial surgeon reshapes the skull bones. The bones are usually fixed with stainless-steel wires or stitches; absorbable plates and screws are used occasionally. The wound is closed with absorbable stitches and a head bandage is applied.

Your child spends the first night in the ICU and then moves to the ward. Expect marked swelling of the head and face — the eyes may close for 3–4 days — which settles over the week. Children usually go home on the sixth or seventh day, after the bandage is removed, and can have a head shower after that.

After Open Surgery

You will have periodic follow-up with the craniofacial surgeon and neurosurgeon. This is usually a one-time operation: if there is no associated syndrome, it is all your child will need. Orthotic Helmet Therapy is not needed after open remodelling. Small gaps in the skull close over within 2–3 years, and the scar is usually well hidden in the hair.

Possible Complications

This is major surgery and families should be fully informed. Infection, bleeding, scarring, swelling and pain are the common complications, and the team manages them routinely. A small tear in the covering of the brain is sometimes seen and is usually repaired during the operation. Injury to the eye or brain is very rare. Death is a remote theoretical possibility; Dr Deraje's team has not seen it in their practice.

Frequently Asked Questions

Other Types of Craniosynostosis

• Sagittal Synostosis — Long, narrow head (Scaphocephaly) — the most common single-suture type.
• Metopic Synostosis — Triangular, keel-shaped forehead (Trigonocephaly).
• Unicoronal Synostosis — One side of the forehead flattened, with a slanted skull (Anterior Plagiocephaly).
• Bicoronal Synostosis — Both coronal sutures fused — a flat, wide head (Brachycephaly).
• Multisuture & Syndromic Craniosynostosis — Several sutures fused, often with a syndrome such as Crouzon or Apert.

Craniosynostosis Surgery in Bangalore — Full Overview