Defining the best practices

Doernbecher Children’s Hospital has the largest program in Oregon for the repair of skull birth defects called cranial synostosis. In synostosis, one or more of the skull growth plates is missing, which can cause a severely misshapen head, pressure on the brain, developmental delay and even blindness.

Surgery to repair synostosis requires an accredited specialty team comprising a pediatric neurosurgeon and a pediatric craniofacial plastic surgeon.

At Doernbecher, I am privileged to do this work with one of the best craniofacial plastic surgeons in the country, Dr. Anna Kuang.

We typically perform more than 40 major reconstructive operations for skull deformity in infants each year. Unfortunately, even after surgical repair of a skull deformity as a baby, there is a risk in the first few years of life that the problem will recur.

At Doernbecher, Dr. Kuang and I were anxious to predict which children might suffer this rare complication. To tackle this problem, we analyzed the results of surgery on more than 150 children undergoing treatment at Doernbecher.

From this study, Dr. Kuang and I learned two important things. First, thankfully, recurrence rates at Doernbecher are among the lowest reported. Second, and even more importantly, we identified a small subset of patients at more risk for recurrence and a strategy for timing their surgery to improve the chances of a permanent result from the first operation.

Along the way, we identified some findings on routine post-surgical follow up testing that could confuse surgical teams into over-diagnosing recurrence and undertaking unneeded operations.

Dr. Kuang and I reported these important findings during the past year in two major surgical journals: Plastic and Reconstructive Surgery and the Journal of Neurosurgery. We each also travelled to national surgical meetings to present our results immediately to other program leaders from around the country (and the world).

By taking these additional steps, we can help make sure that all children benefit from the research and quality improvement efforts taking place at Doernbecher and OHSU. Our mission is not only the best care for any child that comes to us from Oregon and the region, but also for every child no matter where their care is given.

Nathan Selden, M.D., Ph.D.
Mario and Edie Campagna Chair of Pediatric Neurosurgery
Director, OHSU Neurological Surgery Residency Program
OHSU Doernbecher Children’s Hospital