26-4: Craniosynostosis Repair

What is craniosynostosis?
a. Inflammation of the cranial nerves
b. Fracture of the infant skull
c. Premature closure of cranial sutures
d. Infection of the meninges

c. Premature closure of cranial sutures

Why must cranial sutures remain open until around age 2?
a. To allow skull reshaping during sleep
b. To provide cushioning for the brain
c. To allow brain expansion and growth
d. To prevent fluid accumulation in the skull

c. To allow brain expansion and growth

What can result if craniosynostosis is left untreated?
a. Hearing loss
b. Increased risk of epilepsy
c. Brain damage due to restricted growth
d. Delayed tooth eruption

c. Brain damage due to restricted growth

What is the primary goal of craniosynostosis repair surgery?
a. To remove excess brain tissue
b. To fuse all cranial sutures early
c. To reshape the skull and allow brain growth
d. To implant a cranial shunt

c. To reshape the skull and allow brain growth

What is a possible long-term complication if craniosynostosis is not surgically corrected?
a. Scoliosis
b. Hydrocephalus
c. Cerebral palsy
d. Increased intracranial pressure

d. Increased intracranial pressure

What is the primary objective of the surgical repair of craniosynostosis?
a. Drain excess cerebrospinal fluid
b. Excise damaged brain tissue
c. Open and reshape the fused sutures to allow brain growth
d. Reinforce cranial bones with synthetic material

c. Open and reshape the fused sutures to allow brain growth

1-Where is the incision made during a craniosynostosis repair?
a) Along the sagittal suture
b) From forehead to occiput
c) Midway between anterior and posterior fontanelles from ear to ear
d) Around the orbit

c) Midway between anterior and posterior fontanelles from ear to ear

2-What is the main reason the pericranium is left attached to the skull during craniosynostosis repair?
a) To provide structural support
b) To reduce infection risk
c) To minimize bleeding
d) To promote faster bone healing

c) To minimize bleeding

2-What instrument is used to elevate the scalp from the skull in craniosynostosis repair?
a) Penfield dissector
b) Periosteal elevator
c) Freer elevator
d) Cobb elevator

b) Periosteal elevator

3-During a craniosynostosis repair, what instrument is commonly used to create the initial bur hole in the skull?
a) Kerrison punch
b) Midas Rex drill
c) Penfield dissector
d) Raney clip applicator

b) Midas Rex drill

3-What should the CST do during use of the Midas Rex drill in craniosynostosis repair?
a) Apply suction continuously
b) Monitor oxygen levels
c) Irrigate the drill
d) Clamp the scalp flaps

c) Irrigate the drill

4-Which instrument is used to cut anteriorly to the anterior fontanelle on each side of the sagittal suture during craniosynostosis repair?
a) Midas Rex drill
b) Craniotome
c) Gigli saw
d) Kerrison rongeur

b) Craniotome

5-What is the Leksell rongeur used for during craniosynostosis repair?
a) Elevating the dura
b) Closing the skin incision
c) Connecting bur holes across the sagittal suture
d) Draining cerebrospinal fluid

c) Connecting bur holes across the sagittal suture

5-What should be available to collect bone fragments when using a rongeur?
a) Yankauer suction
b) Gelfoam sponge
c) Laparotomy sponge
d) Moist sponge

d) Moist sponge

6-Which instrument is used to dissect the sagittal suture off the underlying dura?
a) Penfield dissector
b) Cobb periosteal elevator
c) Freer elevator
d) Leksell rongeur

b) Cobb periosteal elevator

7-Where is a bur hole placed during craniosynostosis repair to allow access for bone removal?
a) At the foramen magnum
b) At the lambda
c) At the asterion on each side
d) At the anterior fontanelle

c) At the asterion on each side

7-During craniosynostosis repair, where is the craniotome used to make a cut after placing a bur hole at the asterion?
a) Just anterior to the lambdoid suture
b) Just anterior to the coronal suture
c) Just posterior to the coronal suture
d) Just posterior to the sagittal suture

c) Just posterior to the coronal suture

8-What bone is intentionally fractured while leaving the periosteum intact during craniosynostosis repair?
a) Temporal
b) Occipital
c) Frontal
d) Parietal

d) Parietal

9-What type of suture is typically used for skin closure in craniosynostosis repair?
a) 2-0 nylon
b) 3-0 and 4-0 absorbable sutures
c) 5-0 prolene
d) 3-0 and 4-0 nonabsorbable sutures

b) 3-0 and 4-0 absorbable sutures

How long does a typical hospital stay last after craniosynostosis repair, if there are no complications?
a) 1–2 days
b) 10–14 days
c) 3–7 days
d) 8–12 days

c) 3–7 days

What postoperative device may be used to guide skull development after craniosynostosis repair?
a) Halo traction
b) Cervical collar
c) Molded helmet
d) Craniotomy brace

c) Molded helmet

What may be necessary postoperatively following craniosynostosis repair to address blood loss?
a) Diuresis
b) Sedation
c) Blood transfusion
d) Dialysis

c) Blood transfusion

All of the following are potential complications of craniosynostosis repair EXCEPT:
a) Infection of the brain
b) Brain swelling
c) Damage to brain tissue
d) Spinal cord inflammation

d) Spinal cord inflammation