10 Questions to Ask the Surgeon Before Your Child's Craniosynostosis Surgery
Few moments in parenting feel as overwhelming as when you learn that your child may require surgery for craniosynostosis. Knowing what to ask during a surgical consultation can help to make the process feel more manageable.
Dr. Sharline Aboutanos, a board-certified plastic surgeon and Fellow of the American Academy of Pediatrics, works closely with Richmond-area families facing a craniosynostosis diagnosis. Here, she shares the ten questions that can help you gain clarity during your meeting with your child’s surgeon.
1. Are you fellowship-trained in craniofacial and pediatric plastic surgery?
Experience and specialized training matter enormously for a condition as complex as craniosynostosis. Parents should confirm their surgeon has dedicated training, beyond general plastic surgery experience. Board certification is important, but fellowship training in craniofacial surgery represents additional years of specialized experience and education focused specifically on conditions affecting the skull and face. This level of expertise directly impacts surgical outcomes and the surgeon's ability to handle complications should they arise.
2. Do you work as part of a craniofacial team?
Craniosynostosis often requires coordinated care. Dr. Aboutanos is a member of the accredited Cleft and Craniofacial Team at St. Mary's Hospital—a multidisciplinary team that helps children receive comprehensive evaluation and treatment. These teams typically include plastic surgeons, neurosurgeons, pediatric anesthesiologists, pediatricians, and other specialists who collaborate on your child's care. This team structure means your child benefits from multiple expert perspectives rather than a single surgeon working in isolation.
3. Is this syndromic or nonsyndromic craniosynostosis?
Nonsyndromic craniosynostosis typically involves a single suture and occurs in isolation, while syndromic craniosynostosis is associated with genetic conditions like Apert or Crouzon syndrome and often involves multiple sutures and other physical concerns. The answer to this question shapes everything—the surgical approach, the timeline, and what other specialists may need to be involved. The distinction also determines what additional evaluations and long-term monitoring your child may need.
4. Which suture is affected, and how severe is it?
Not all cases of craniosynostosis are the same. The location and degree of premature fusion influences both urgency and surgical options. The sagittal suture, metopic suture, coronal sutures, and lambdoid sutures each create different head shape abnormalities when fused prematurely, and some locations carry higher risk for increased intracranial pressure than others. Understanding which suture is affected helps parents grasp why their surgeon is recommending a particular approach and timeline.
5. Could this be positional plagiocephaly instead?
Positional plagiocephaly results from external pressure on the skull and typically resolves with repositioning or helmet therapy, while craniosynostosis requires surgical intervention. Getting the correct diagnosis prevents unnecessary surgery or, conversely, delays in needed treatment.
The two conditions are frequently confused by families—and sometimes by general practitioners. A fellowship-trained craniofacial surgeon can distinguish between them, usually by physical exam alone, and make sure the right treatment path is pursued.
6. What surgical approach will you use for my child, and why is it the right choice?
The most common surgical approaches for craniosynostosis include open cranial vault remodeling, which reshapes the skull through a larger incision and provides immediate visible correction, and endoscopic strip craniectomy, a minimally invasive option for very young infants (typically under 4 months) that requires helmet therapy afterward to guide skull shaping. Some surgeons offer both approaches, while others specialize in one technique based on their training and experience. Ask your surgeon which approach they're recommending, why it's appropriate for your child's age and type of craniosynostosis, and what alternatives exist if any.
“Thank you so much for taking care of our daughter today. We knew the first time we met that you were the perfect doctor for us. We felt quite reassured that her care was in the best hands. Thank you so much for what you do and ensuring that our daughter's surgery went well today. We very much appreciate your thoughtful efforts and expertise.”
—Testimonial from Parent of Patient
7. What is the ideal timing for surgery, and what happens if we wait?
Earlier intervention typically means more surgical options and better outcomes. Some cases require prompt surgery to relieve intracranial pressure and prevent developmental delays, while others may have more flexibility in timing. Ask your surgeon how urgent your child's case is and what risks exist if surgery is delayed. This clarity helps you plan appropriately without second-guessing whether you should have acted sooner.
8. Will my child need a blood transfusion, and how is that risk managed?
This is one of the most common concerns parents have going into craniosynostosis surgery. A thorough answer—including what measures are taken to minimize that risk—goes a long way toward easing anxiety. Modern surgical techniques use cell savers during surgery to collect and recycle the child's own blood, and certain medications help reduce blood loss. Pre-operative blood work includes typing and crossmatching to prepare for possible transfusion if needed. Understanding these precautions helps parents feel more prepared for what may occur.
9. What does recovery look like at home, and what should I watch for?
Hospital stay length, activity restrictions, warning signs, and follow-up appointments all need to be clearly outlined before discharge so families feel prepared rather than caught off guard. Parents should understand how to care for their child's incision, what level of swelling is normal versus concerning, when pain medication should be given, and which symptoms require immediate medical attention. For children undergoing endoscopic surgery, this conversation should also cover helmet therapy expectations—when it starts, how long it's needed, and how the helmet will be adjusted over time.
10. Will my child need additional surgeries or long-term monitoring?
Some children require follow-up procedures as they grow. Understanding the possibility upfront helps families plan and removes the fear of the unknown. Children with syndromic craniosynostosis may need staged procedures or additional surgeries to address other craniofacial concerns as they develop. Even children with nonsyndromic craniosynostosis require monitoring throughout early childhood to ensure proper skull growth and brain development. Knowing what follow-up care looks like allows families to budget time and resources accordingly.
Families in the Richmond area navigating a craniosynostosis diagnosis are welcome to contact Dr. Sharline Aboutanos to schedule a consultation and get the answers they need. Call (804) 355-3410 or fill out our online contact form to discuss your child's specific situation.