Craniosynostosis
Craniosynostosis is a condition in which one or more of the joints between a baby's skull bones, called sutures, close too early. Any suture can be affected. The sagittal suture is most commonly involved, causing scaphocephaly; premature closure of the metopic suture, causing trigonocephaly, is less common. These conditions are reported in approximately 1 in 1,800 births and are more common in boys. Assessment may include a physical examination and head measurements, feeling the affected suture, X-rays, ultrasound and, when needed, a CT scan.
Once the diagnosis is confirmed, surgery is usually recommended. If the condition is diagnosed early while the skull is still growing rapidly, a less invasive endoscopic operation may be possible, followed by treatment with a cranial remoulding helmet. When diagnosed later, more extensive surgery to reshape the skull is often needed; a protective helmet may sometimes be recommended afterwards. The treating neurosurgeon decides which approach is appropriate. We make both types of helmet from a 3D scan of the patient's head.
Scaphocephaly
Scaphocephaly develops when the sagittal suture closes too early. This suture runs from front to back along the top of the head, between the two parietal bones. Early closure limits sideways growth, while the head continues to grow forwards and backwards. This produces a characteristic long, narrow, boat-shaped head, often with a prominent forehead and an elongated back of the head.
Trigonocephaly, synostotic plagiocephaly and brachycephaly
Trigonocephaly is a less common form of craniosynostosis caused by early closure of the metopic suture. Viewed from above, the forehead appears triangular and the eyes may be unusually close together. Early closure of the lambdoid or coronal sutures is less common still.
Trigonocephaly
Lambdoid suture fusion
Coronal suture fusion
For patients
What do I need before receiving an orthosis?
A cranial orthosis (helmet) may be prescribed after endoscopic surgery for craniosynostosis to guide head growth, or as a protective helmet following injury or for other medical reasons.
For approval by a Czech health insurance provider, the following documentation is required:
- A prescription and request for an orthopaedic medical device (code 4000002 for patients under 18 and 4000001 for adults).
- A valid prescription issued within the previous 30 days, unless the prescribing doctor specifies otherwise.
Treatment with a cranial remoulding orthosis
For children, the cranial remoulding orthosis is fully covered by Czech public health insurance under the stated coverage conditions. For an adult protective helmet, public health insurance covers 99% and the patient pays 1%.
What does the fitting process involve?
Initial medical assessment
A specialist doctor decides whether treatment is appropriate. Relevant specialists include neurologists, surgeons, neurosurgeons, orthopaedic surgeons and rehabilitation physicians, who can also prescribe the helmet. An anthropological assessment measures cranial indices, evaluates the severity of the head shape difference and assesses skull growth potential using percentile charts.
Assessment by an orthotist at our clinic
We measure cranial indices and capture the shape of the head using a 3D scanner. Our clinic uses advanced scanning technology to keep the process comfortable for your child.
Making the cranial orthosis
We shape and adjust the 3D model on a computer and mill it using a CNC machine. The model is then finished by hand. Each helmet is individually made using materials suitable for medical use. We choose materials such as foam plastics and antibacterial fabric to keep the helmet as light and well ventilated as possible, reduce sweating and support comfortable wear without restricting the child's development.
Helmet fitting and instructions for parents
At the fitting appointment, we make the final adjustments and provide the helmet. Parents receive instructions on putting it on, hygiene and follow-up visits. Reviews are usually scheduled approximately every four weeks, or earlier if an adjustment is needed.
Follow-up and completion of treatment
Treatment may end once a satisfactory head shape has been achieved, when the child is over 18 months old, if no improvement has been recorded over two months despite consistent wear, or if the child cannot tolerate the helmet. The treating team assesses when treatment should finish.
Frequently asked questions
How soon will we see results?
How long does it take for a baby to get used to the helmet?
Wear time is increased gradually to reduce the risk of skin irritation and pressure problems. Most children adapt quickly, although minor pressure marks or heat rash can occur. Occasionally a baby may not tolerate the helmet at all.
At our clinic, approximately 95% of children successfully adapt to wearing the orthosis.
How can I tell if the helmet needs adjusting?
More extensive adjustments to the helmet lining may also be necessary when the prescribed schedule is not followed and the helmet is worn for fewer than 22 hours a day.
What should I do if there are significant pressure marks or a rash?
What if my baby becomes ill and cannot wear the helmet?
If pressure marks do not fade, follow the guidance above and contact your orthotist.
How can we improve a positional head shape difference without a helmet?
Vary your baby's head position and the direction of light, toys and interaction while they are awake and supervised, encouraging them to look away from the flattened side. For every sleep, place your baby on their back on a firm, flat surface. Do not use sleep positioners, pillows or wedges to hold the head in place.
Alternate sides during bottle feeding. Offer frequent, supervised tummy time while your baby is awake, building up gradually as tolerated. Limit unnecessary time in car seats when not travelling, to reduce prolonged pressure on the back of the head.