COLIN VAN VLECK - 4 Weeks (2009) - Arlington/Bennington VT

Jury draw scheduled in alleged shaking death of baby(video)


Arlington, Vermont -- October 17, 2011
By Molly Smith - bio | email
An Arlington man is set to stand trial this week for allegedly shaking his 5-week-old baby to death.

Russ Van Vleck, 28, faces felony charges for allegedly shaking his 5-week-old son, Colin, to death in October of 2009. The case has been postponed several times, but jury draw is scheduled to start Monday.

Investigators say Van Vleck was alone with his baby boy when the child became nonresponsive and was later pronounced dead at the hospital. The medical examiner concluded the baby suffered head and neck trauma consistent with being shaken to death.

But the defense argues the ME's office used outdated science to reach that conclusion and claims the baby's injuries were caused by complications at birth.

Just minutes before trial was set to start in June, state prosecutors wanted a defense expert witness thrown out because they were given late notice. But instead, the judge gave them more time to work with the witness.

"In normal course when experts rely on documents, both sides have equal opportunity to review those records," said Assistant Bennington County State's Attorney Christina Rainville.

"The court tried to conduct a balance to see if we could juggle the schedule, but the way these experts are locked in, it's just extremely difficult," said defense attorney William Wright. "Ultimately what we need is a fair trial."

Both sides are expected to rely heavily on expert testimony for this case.

http://www.wcax.com/story/15708533/trial-to-begin-in-alleged-baby-shaking-death

Tom, just curious, did the medical examiner mention any other findings that would support the flu the baby was said to have prior to his death?

mom_in_il wrote:Tom, just curious, did the medical examiner mention any other findings that would support the flu the baby was said to have prior to his death?

---No, not to my knowledge. I have never heard of flu symptoms mimicking shaken baby syndrome.

As police investigated Colin's death, they found that he had been sick
for several days before his death. He also had a deformity to his head
because of complications from his birth and both parents said they had a
history of sudden infant death syndrome in their families.

Vermont Chief Medical Examiner Dr. Steven Shapiro, however, found that Colin
had been a normal, healthy child and that Colin's cranial deformity did
not contribute to his death.

"Dr. Shapiro would convey that his findings revealed that Colin had
blood on his brain, an indicator of trauma to the head. Dr. Shapiro
indicated the trauma causing Colin's death was believed to have occurred
within a 24-hour period prior to his
death with the likelihood greater that the trauma occurred closer to the end of the time frame than the start," Patten said.

You think for one minute I'm going to sit here and help a bunch of misguided forum trolls on their mission to help spread lies and bullshit on the internet :) You all are as retarded as you sound. You don't think I have a couple thousand pages of court documented reports on this case? Maybe even the coroners report and the autopsy? IF you all actually gave a real consideration about any of these cases you would solicit each and ever court for all the documentation as you are legally entitled. Then maybe all of you ignorant individuals would know the facts about these cases that you are trying SO HARD TO FIND THE FACTS ON. Instead you all post retarded articles to media propaganda. Who is the joke? Your entire forum is a joke. If any of you actually lived in our community you would know how many times articles written by Keith Whitcomb have been incorrect or misleading. You know NO FACTS. So stop your squawking TomTerrific, and all you cronies. You sound like a bunch of old maids sitting around a kitchen table gossiping about things you haven't an idea. OMG THE NEWSPAPER SAID WHAT, OH THAT MUST DEFINITELY BE FACT. I bet you all voted for the lead runner in the republican or democratic party in 2008 as well instead having one iota of independent thought. You all are sheep. Let me summarize how this entire forum thread has gone. "Tom posts B.S. new articles. I email admin to respectively remove lies from the website because they are just not true. Admin posts email to thread to try and make me look like an idiot. Cronies all chirp in claiming that I am an idiot. I post personal defense. Tom chirp chirp chirps some more, cronies come to his aid. One of my mutual friends come in and posts, whom I hadn't known was going to do this (who also has a bit more of clue than all of you about this case), you all bash her calling her an idiot. Tom chirps some more about how smart he is about legal procedure and yet doesn't understand why we won't give him all the facts that he so easily could get because he's a lazy FAT keyboard troll (don't get red in the face now Tom, we all know you are). But yet we are the idiots that have posted nothing but drivel. You keep posting that idiot Keith Whitcombs nonsense Tom, I don't know who is more stupid, the parrot or the author. Good luck with your Life because you clearly don't have one Mr. Posts: 26329 Joined date: 2008-10-20. What's that 74 posts in one day, in one forum? LOL LOOK AT YOU MR. KEYBOARD COWBOY.

Trial starts in alleged shaken baby death

By Deanna LeBlanc - bio | email

Bennington, Vermont - October 17, 2011

Trial started Monday for an Arlington man accused of shaking his 5-week-old baby to death.

Prosecutors say 28-year-old Russ Van Vleck was alone with his baby when the boy became nonresponsive and later died.

The medical examiner says the baby suffered head and neck trauma consistent with being shaken to death.

The defense argues the medical examiner used outdated science to reach that conclusion. They claim the baby's injuries were caused by complications at birth.

http://www.wcax.com/story/15714769/trial-starts-in-alleged-shaken-baby-death

dewbiez wrote:You think for one minute I'm going to sit here and help a bunch of misguided forum trolls on their mission to help spread lies and bullshit on the internet :) You all are as retarded as you sound. You don't think I have a couple thousand pages of court documented reports on this case? Maybe even the coroners report and the autopsy? IF you all actually gave a real consideration about any of these cases you would solicit each and ever court for all the documentation as you are legally entitled. Then maybe all of you ignorant individuals would know the facts about these cases that you are trying SO HARD TO FIND THE FACTS ON. Instead you all post retarded articles to media propaganda. Who is the joke? Your entire forum is a joke. If any of you actually lived in our community you would know how many times articles written by Keith Whitcomb have been incorrect or misleading. You know NO FACTS. So stop your squawking TomTerrific, and all you cronies. You sound like a bunch of old maids sitting around a kitchen table gossiping about things you haven't an idea. OMG THE NEWSPAPER SAID WHAT, OH THAT MUST DEFINITELY BE FACT. I bet you all voted for the lead runner in the republican or democratic party in 2008 as well instead having one iota of independent thought. You all are sheep. Let me summarize how this entire forum thread has gone. "Tom posts B.S. new articles. I email admin to respectively remove lies from the website because they are just not true. Admin posts email to thread to try and make me look like an idiot. Cronies all chirp in claiming that I am an idiot. I post personal defense. Tom chirp chirp chirps some more, cronies come to his aid. One of my mutual friends come in and posts, whom I hadn't known was going to do this (who also has a bit more of clue than all of you about this case), you all bash her calling her an idiot. Tom chirps some more about how smart he is about legal procedure and yet doesn't understand why we won't give him all the facts that he so easily could get because he's a lazy FAT keyboard troll (don't get red in the face now Tom, we all know you are). But yet we are the idiots that have posted nothing but drivel. You keep posting that idiot Keith Whitcombs nonsense Tom, I don't know who is more stupid, the parrot or the author. Good luck with your Life because you clearly don't have one Mr. Posts: 26329 Joined date: 2008-10-20. What's that 74 posts in one day, in one forum? LOL LOOK AT YOU MR. KEYBOARD COWBOY.

I am not defending Tom. But I find your use of the "R" word ignorant and offensive, in this day and age. If you do not like what is posted on this site, simply stay away. This is a baby"s short life and death, being played out in the courts. Save your opinions for your testimony.

Methinks he doth protest too much.
What I do with my spare time is of little concern of yours "dewbiez".
I would however, be happy to compare my record of real live (not behind a keyboard) public service against yours. I am certain it would make yours pale in comparison. Your implications that I am lazy and/or fat are certainly without facts but then again why should that concern someone who so obviously ignores the facts of a medical examiner's investigation.
I am quite happy with my life the way it is, thanks very much, however it would be even more pleasant if you would just please stop using our forum as a place to vent your imbecilic drivel. Troll? I think not. Just a caring person who sees injustice and horrors heaped on the defenseless every day and hopes that one day it will stop.
I must go now and post more stories about children who are killed or maimed by their caregivers. Care to help?

Whoa....thats a nasty piece of work. If I were the accused guy i'd want my supporters such as 'dewbiez' to keep a low profile because as a supporter trying to convince people of his innocence, 'dewbiez' ain't doin a great job, he/she (can't tell if the angry rant is male/female) comes across as an angry deadbeat who has obviously lost sight of the fact that a baby is dead. God help Russ Van Vleck if this person is testifying for him!!!!!!! Nasty nasty person.

Trial surrounding infant’s death begins; likely to rely on science

Russ Van Vleck of Arlington went on trial for manslaughter Monday for the alleged shaking death of his 5-week-old son, Colin, in 2009. A jury in Bennington Superior Court, Criminal Division, heard state Medical Examiner Steven Shapiro testify. Photos of Van Vleck performing CPR on a doll were also admitted into evidence. (Peter Crabtree)
Monday October 17, 2011
KEITH WHITCOMB JR.

Staff Writer

BENNINGTON -- A jury spent Monday, the first day of what’s expected to be a long trial focusing on the death of an Arlington infant, listening to a 911 call made by his father and hearing testimony from the state medical examiner.

Russ C. Van Vleck, 28, father of Colin Van Vleck, who died in October 2009, pleaded not guilty to one count of manslaughter in March of last year, after Medical Examiner Dr. Steven Shapiro declared the 5-week-old infant’s death a homicide.

The trial in Bennington had been scheduled to begin in June, but last-minute disagreements between the state and Van Vleck’s defense team over some of the experts who would be testifying delayed the trial for a few months.

Attorneys in the case have said the trial will make heavy use of expert witnesses and much of the evidence is scientific. The trial is scheduled for the next two weeks.

"The evidence is going to show that Russ caused Colin’s death in a moment’s rage, a moment’s loss of control, and that Colin died of massive internal injuries consistent with being violently shaken, or being thrown into a soft object like a couch, a crib mattress, a bassinet, or a padded chair," said Deputy State’s Attorney Christina Rainville in her opening statements.

Before the trial began, Joyce Brenner, Van Vleck’s attorney along with attorney William Wright, filed a motion to dismiss the case on the grounds the state hadn’t specified what act of Van Vleck’s caused the boy’s death. Judge David Howard ruled that that wasn’t grounds for dismissal and could be addressed during jury instructions before deliberations.
Rainville said the infant had no external injuries or broken bones. She said he had evidence of hemorrhages in his eyes, areas of his brain, neck, and spine.

According to Rainville, Shapiro’s examination did not find the kind of blood cells in the hemorrhages and other internal injuries that would be present as part of the healing process, which she said was an indication the bleeding occurred not long before the boy’s death.

She said Colin Van Vleck had been suffering with a stomach virus in the days before Oct. 2, 2009, and had been to the doctor’s office about it. She said the child had gotten over the illness, and witnesses would testify that the child seemed fine that day. She said it would likely be the child’s mother, Lindsay Van Vleck, who would testify that the child seemed fine when she left the house at 8:30 p.m.

Rainville said there are discrepancies between statements Russ Van Vleck gave to police. In one, she said, he told the 911 dispatcher the baby had been crying, but told police he hadn’t. She said he’d also claimed to have fed the child not long before he died, but the autopsy found no food in his stomach or intestines.

She said the defense intends to propose the child died of a condition he had at birth that created pressure on his brain, but medical experts will testify than no child anywhere has been shown to die from what the defense suggests killed Colin Van Vleck.

Brenner, in her opening statements, said Colin Van Vleck’s birth was a difficult one. She said his head was misshapen from "single suture craniosynostosis," a condition in which two plates on the child’s skull are fused. Normally, none of the plates are fused, which allows the baby’s brain room to grow. Brenner said the defense’s evidence will show that single suture craniosynostosis can cause pressure on the brain, which can explain the child’s internal injuries.

She said the outward signs of "intracranial pressure," or pressure inside the skull, can be vomiting and "fussiness" which also happen to be signs of gastro-intestinal disease. She said Dr. Michael Welther, the Arlington doctor the child was seeing, isn’t familiar with single suture craniosynostosis and will testify to that.

According to Brenner, the child’s injuries can be explained by a condition he had at birth, while some near the neck are consistent with him being held by his father who performed CPR with coaching from the 911 operator.

Brenner said that evidence will also show Russ Van Vleck to be a caring father who supported his wife throughout the pregnancy and difficult birth. She said there was no evidence of external injuries, which shows the child was not abused.

"You will not hear anything about Russ going into a rage; you will not hear about him mistreating his child," she said.

She said a child did die, and whenever that happens people want answers. She said a number of medical theories have come up to explain infant deaths, but the medical community is not in complete agreement on them. She said the Van Vleck family has been torn apart by the allegations and the evidence will show he isn’t guilty.

Wright said in an interview after the day’s proceedings concluded part-way through Shapiro’s testimony that the case is complex and he intends to call expert witnesses to dispute Shapiro’s conclusions. He said he doesn’t know if the defense will begin its portion of the case this week or next.

Howard told the jury they would be starting the trial each day at 8:30 a.m., breaking around noon for an hour, then ending each day around 4:30 p.m. depending on where a witness is in their testimony.

http://www.benningtonbanner.com/local/ci_19134745

I apologize for the usage of certain words but the individual's pugnacious arrogance infuriates me.

dewbiez wrote:I apologize for the usage of certain words but the individual's pugnacious arrogance infuriates me.

---Apology accepted.

Now we are getting somewhere...

Single-suture synostosis includes isolated fusions of the sagittal, metopic, and left or right coronal or lambdoid sutures.
In Figure 1(Panel A) these sutures are shown on a three-dimensional CT (computerized tomography) scan of a normal skull. Metopic synostosis (Figure 1, Panel B) produces a triangular head shape (trigonocephaly) that features a forehead midline ridge, frontotemporal narrowing on both sides of the head, and a broad parietal-occiput.
Unilateral coronal synostosis (Figure 1, Panel C) is characterized by an asymmetrically skewed head (plagiocephaly) with retrusion of the forehead and brow on the same side as the fused suture and with compensatory “bossing” (bulging) of
the forehead on the side opposite of the fused suture. Plagiocephalic head shape is also found in cases of unilateral lambdoid synostosis,
characterized by occipital retrusion on the fused side and by bossing
in the occipital and frontal areas on the opposite
side. Plagiocephaly associated with unilateral coronal
or lambdoid synostosis can be distinguished clinically from the
relatively
common “positional” or “deformational” plagiocephaly,
which is believed to result from external forces shaping the infant’s
malleable skull (e.g., invariant sleeping position;
see Mulliken, Van Der Woude, Hansen, LaBrie, & Scott, 1999). Sagittal synostosis (Figure 1, Panel D) is manifest at birth as a long, narrow head shape (scaphocephaly) with bifrontal and occipital bossing.



From a clinical perspective, the studies reviewed suggest that the
outcomes of most children with isolated synostosis (slightly
more than half) are indistinguishable from those of
typical children. However, a sizable minority (perhaps 30% to 40%) is
likely to have problems in need of intervention.
This tentative estimate of risk suggests that routine neurodevelopmental
screening and referral would benefit children with
synostosis, especially preschool-age children for whom the benefits of
early assessment and intervention have been well
demonstrated (Shonkoff & Meisels, 2000).


Results Isolated craniosynostosis is associated with a
three- to fivefold increase in risk for cognitive deficits or
learning/language
disabilities. The causal basis for this association
is unclear. No particular calvarial suture (sagittal, metopic, left or
right unilateral coronal) has been associated with
higher risk of problems. There is little evidence from
quasi-experimental
studies that cranioplastic surgery prevents or
reduces risk of neurobehavioral impairment.

Poster's Note: The conclusions that I am drawing here are that since it was a "single" CS that the risk of increased brain pressure (enough to cause a fatal brain bleed) was extremely small. Had the entire skull been fused the risk would be much higher and probably required surgical intervention. The biggest, and most likely, risk would be psychological or behavioral and that only presents itself in less than 50% case rate.

She said Colin Van Vleck had been suffering with a stomach virus in the days before Oct. 2, 2009, and had been to the doctor’s office about it


This supports my statement about him being sick!! Just for those who doubted my statement!

Colin will always be remembered by many! Although he spent only a few short weeks here on Earth all that new him will never forget the time we had with him. But I don't feel that I need to always post my emotional state about how I feel about his passing. It isn't easy to write about it when I have a child of my own.

The next 2 weeks are key because we have already lost one life we don't need to lose another behind bars for something he didn't do. I will be sitting in for the rest of the trial after I testify to get key facts that obviously I have never heard. I wish Russ and the Van Vleck family the best!

Manslaughter trial of father in child’s death continues

Posted: 10/18/2011 10:47:35 PM EDT

Tuesday October 18, 2011
KEITH WHITCOMB JR.

Staff Writer

BENNINGTON -- The trial of a man accused of killing his 5-month-old son "in a moment’s rage," concluded its second day with motions by the defense regarding potential character witnesses and expert testimony.

Russ C. Van Vleck, 28, of Arlington, pleaded not guilty early last year to one count of manslaughter after the State Medical Examiner ruled the death of his son, Colin Van Vleck, was the result of a homicide. The state has accused Van Vleck of violently shaking or throwing the child against a soft object, causing internal injuries that killed him.

Bennington attorney William Wright, assisted by attorney Joyce Brenner, are arguing their client’s son died of a condition he had at birth that caused plates in his skull to fuse too early, leading to pressure on the brain and subsequent death.

Both the state and defense say the trial relies heavily on the testimony of medical experts. It’s been scheduled to last two weeks.

Judge David Howard, after the jury recessed for the day, heard arguments from Deputy State’s Attorney Christina Rainville and Wright on the admissibility of testimony related to Van Vleck’s character. Wright said some of his witnesses may testify that his client is not prone to reckless or careless behavior. He said the state hasn’t charged Van Vleck with a specific act, an issue he raised before the trial, and is charging him with a type of behavior. He said he must be allowed to defend that accusation.
Rainville said case law prohibits the defense from citing specific acts that speak to Van Vleck’s character, but they can find people in the community to speak two his general behavior and actions.

Brenner had argued about the state’s intention to call Dr. Karyn Patno, a Burlington pediatrician, saying what the state intends to have Patno testify on has been raised, or could be addressed, by other witnesses. She said the state is not allowed to simply put on multiple experts to strengthen their case through numbers.

Rainville said Patno will speak to specific aspects of the case not covered by other witnesses, such as Dr. Steven Shapiro, the State Medical Examiner who performed the Colin Van Vleck’s autopsy. She said the defense is also trying to make it so the state relies on witnesses the defense plans to attack as being unreliable because of the extent of their medical knowledge.

The jury spent Tuesday listening to the rest of Shapiro’s testimony, along with that of Dr. Bruce Tranmer, a neurosurgeon at Fletcher-Allen Medical Center. The doctor that oversaw the child’s birth at Southwestern Vermont Medical Center, along with the nurses, were also called.

http://www.benningtonbanner.com/local/ci_19143066

I do not know this man, so i can not presume his innocence or guilt. with the nature of the site, it would be assumed to be a lynching mob for anyone accused. And it is horrific that people do murder their children so that when a baby dies of other reasons the parents not only have to mourn the loss of their baby but defend themselves. I pray that the soul of Colin is at peace and am so saddened by his death.

I have several links but since I am new it will not allow me to post them

I am a mother of a child who has severe craniosynostosis. She did have surgery, most children do have surgery the study mentioned above ONLY addresses neurobehavior, not physical. At the point they were at, we were still waiting to see specialists as the wait was so long. It was evident when my daughter was born she had it, but many more families have to fight to get a diagnosis, they are told they are crazy when they question the shape of their babies head. They deal with sometimes non stop crying and not reaching developmental milestones, and yet they try feverishly to get help for their child, only to be written off by the medical community or worse yet, suspected of Munchhausen by proxie. The medical community as a whole knows very little if anything about craniosynostosis, the dr who saw the baby close to the time of his death has even admitted not being familiar with it.

With our daughter we were told to watch for signs of inter cranial pressure(she was single suture as well), the biggest of which was vomiting we were told (again we were told this at 2 1/2 months of age when we got in to a neurosurgeon/craniofacial surgeron) that if she began vomiting or her behavior was out of character without a reason or for a prolonged time, that we should report to the children's hospital emergency room (which is 4 hours away).
Cranio CAN cause inter cranial pressure and one possible outcome of that is death. I would be willing to bet that the parents had no idea what was going on. They knew he had an irregular head but likely did not get in yet to correct it, or were told it was just from birth and would correct over time. And when he started to display symptoms of ICP from the craniosynostosis they focused on stomach flu or whatever and tried to treat that. The doctors should be on trial, they did not connect the dots, the irregular head, etc. At the very least a CT should have been ordered. My mother had all the symtoms of carpal tunnel, the doctor even gave her a brace. But she had tumors in her brain, regardless of how well she tried to treat the carpal tunnel, it would not work. So the parents tried to help the baby going to the doctor numerous times it seems.


What is not known is if this child had any syndrome attached with his craniosynostosis. My daughter has one which causes agenesis of the corpus colosum, and other conditions in addition to the cranio (again single suture). There are more than 180 syndromes related to craniosynostosis. A syndrome is a collection of symptoms, so while cranio can be isolated, it can also be part of something else. For example, my daughters causes wide set eyes, poor eyesight, a missing corpus callosum (part of your brain), slanted shoulder, fingernail issues etc. Others have more severe symptoms. Again, the poster who said if the parents knew he had a mishapened head they were negligent in getting help and should have taken him to the doctor, again I will repeat it is not that easy, you have to see a neurosurgeon/craniofacial surgeon that takes weeks to get into, in addition, the may have been fighting to get a diagnosis or accepted the fact it was mishapen from being born.

Personally everything I read fits, does that mean he definatly did not do it, certainly not. I just would not be so quick to judge. I pray the defense has a qualified ped neurosurgeon testify, not just to dismiss shaken baby but to prove what he had. A good ped neurosurgeon familiar with the surgery required and hopefully a craniofacial surgeon. When they opened my daughter skull in surgery there was enough pressure to hear a pop they said and a sound like a soda opening.

Another interesting article

Here is text of one article search this is from Dr Fearon website in Dallas

Single Suture Craniosynostoses

Overview:

There are four different kinds of single suture synostosis, with each type being caused by a different skull suture prematurely fusing shut. All the single sutural synostoses share some features in common, and these are discussed below. Following this, each type of synostosis (sagittal, coronal, metopic and lambdoid) is discussed individually. Finally, the surgical treatments for the single sutural craniosynostoses are reviewed.

To begin with, it is important to determine if a child truly has craniosynostosis because the most common cause for an abnormal skull shape is not craniosynostosis, but is positional plagiocephaly. Positional plagiocephaly (aka. a skull deformation) is discussed elsewhere on this site (Go to Deformations).

Skull Growth

In order to understand craniosynostosis, it is helpful to know a little bit about the normal growth of the skull. The skull is not made up from one single bone, but instead is made up of different bones. The junctions where these bones meet are called sutures. We know that sutures are very important in growing children. The skull does not usually grow on it’s own; instead, it only gets larger because the brain is growing and putting pressure on the skull to get bigger. So, if the brain does not grow, the skull does not get larger. In the first few years of life, the brain grows very quickly. As the brain grows, it stretches the skull bones apart, with the sutures acting like expansion joints. It is believed that this stretching of the sutures sends a signal to the skull bones telling them to grow bigger so that the skull can accommodate the enlarging brain (actually, the growth of the skull is slightly more complicated that this, and a simplified version is being presented here). If one of these sutures has fused shut, the skull cannot expand to accommodate the growing brain, so the brain must push the other non-fused sutures further apart so there is enough room for the brain. This sequence of events leads to the abnormal skull shape that either parents, or pediatricians first notice.

Fusion of the Suture

What causes sutures to fuse shut before they are supposed to? The two most common causes for premature closure of a suture are either a change in one of the child’s genes, or from outside pressure on the skull. When only one single suture is fused shut, the most common cause is probably “environmental” (or from outside pressure on the skull). We know that it is possible to cause craniosynostosis in animals by restricting skull growth while the animal is still in the womb, and it is very likely that this is the primary cause for the majority of the single sutural synostoses in babies. The uterus, or womb, is a relatively small space. We know that sometimes babies can end up in certain positions in the uterus where they cannot move around freely (for example, the breech position). We suspect that children born with a single sutural synostosis may have been positioned in the uterus so that there is pressure on a part of the skull. If the skull gets caught in a tight place in the uterus, this pressure can restrict the ability of the skull bones to be stretched apart by the growing brain. If the suture is not stretched apart, it “thinks” it’s job is done and it fuses shut with normal bone. Abnormal skull shapes and single sutural synostoses are more commonly seen in twins than in single births, further supporting this theory of in-utero constraint. Craniosynostosis is also more common in boys than girls leading some researchers to speculate that testosterone might make suture closure more likely if there is any restriction of skull growth inside the uterus. Mothers who have delivered babies with single sutural synostosis should not feel guilty that they did anything wrong during their pregnancy to cause this condition. Craniosynostosis occurs in spite of the mother doing everything “right.”

Usually, when children with a single sutural craniosynostosis grow up, they do not pass this trait on to their children. However, it has been reported (and we have seen cases of this, as well) of a single sutural synostosis being passed from generation to generation. This hereditary pattern suggests that the single sutural synostosis is caused by a problem with a gene allowing this trait to be passed from one family member to the next. It is possible to test for some of these genes to see if they are present in children with craniosynostosis (which is something that we are currently doing in Dallas). However, it should be remembered that the overwhelming majority of single sutural synostoses appear to be the product of two parents with normal genes, and a mother who has normal prenatal care. Should children born with a single sutural synostosis decide to have children of their own in adulthood, the chance of passing on the condition is estimated to be less than 2%. If a couple has a child who is born with a single sutural synostosis, the chance of this couple having a another child with a single sutural synostosis is also thought to be about 2%.

Problems Caused by Sutural Fusion

Does a single sutural synostosis affect a child’s development or intelligence? This is a difficult question to answer. At the current time, we believe it either does not affect a child’s mental development, or if it does, it cannot be measured by current testing. There are a number of studies that have been published, which examine the possibility that there may be raised pressure inside of the skull of children born with craniosynostosis. The concern is that if the growing brain is kept from enlarging inside the skull because a suture has closed prematurely, then as the space inside the skull gets more crowded, pressure can build up. Studies suggest that a small percentage of children born with a single fused suture will have raised intracranial (inside the skull) pressure. When a group of children with craniosynostosis were studied with I.Q. testing, it was noted that those children with the highest pressure had lower I.Q.s. The problem is that these were not well-designed studies. To begin with, no one is sure what the normal pressure is inside an infant’s skull, so it is hard to determine exactly what is a high pressure. In addition, we know that pressure inside the skull normally varies up and down and does not stay constant. Furthermore, in some of the studies showing that children with raised intracranial pressure have lower IQ’s, it turns out that those children with the lowest IQ’s had syndromes that are known to have an abnormal brain structure (in some syndromes, we know that the brain may not be wired normally). Finally, the I.Q. test examines only one form of intelligence. There are not good tests for creative intelligence, artistic intelligence, musical intelligence, social intelligence, “common sense”, and other types of intelligence.

There are also some studies that suggest that children with single sutural synostosis may have a higher rate of experiencing some minor developmental or behavioral problems. Once again, it is not clear that these studies are good ones. One of the many criticisms of these studies is that there is not a good “control group” with which to compare children with craniosynostosis. For example, if you were to test a large group of children who do not have craniosynostosis in order to determine if they have developmental or behavioral problems, you would certainly expect to find that some children had these problems. It is difficult to know for sure if a child with craniosynostosis has a higher chance of having developmental or behavioral issues just because of the craniosynostosis. On the other hand, there may in fact be a higher incidence of these problems in children with craniosynostosis. We still do not know the answers to a number of good questions such as: does surgery help to prevent developmental problems? Are there different problems specific to the different fused sutures? Is the brain less affected in those cases where the skull is less affected? It has been our experience that the vast majority of children with a single sutural synostosis are normal children who just have early closure of one of their sutures.

Does Craniosynostosis Need Treatment?

Why is an operation recommended for those children who have a single sutural synostosis? If one considers all that is known about brain growth and development and reviews all the studies examining raised intracranial pressure, blood flow to the brain, and more recently, brain metabolism, the current final conclusion is that most children need surgical treatment. Surgery is meant to return the skull shape and size to where is should be, which gives the child the best chance to develop normally. If children do not look normal, their appearance can have a profound effect on their personality, their willingness to socially interact with their peers, even their desire to go to school. The most difficult decision for surgeons and parents is for those children who are very mildly affected. If the skull is only slightly involved, it is unlikely that there has been a significant impact on the brain and appearance; then we often recommend not operating. You can get more information in the Treatment section.

Listed below are the four types of single sutural synostoses:



Coronal Craniosynostosis (Unilateral Coronal Synostosis, Plagiocephaly)

“Plagiocephaly” is the term used to describe the shape that results from craniosynostosis, or fusion, of either the right or left sides of the coronal suture. The coronal suture runs across the top of the skull, almost from ear to ear. The soft spot, or fontanel, is located midway between the right and left coronal sutures and is usually absent, or closed, in plagiocephaly. On the side of the skull where the suture has closed, one can typically feel a raised ridge of bone. When viewed from above, the forehead on the fused side is further back than the other side (which typically has slightly overgrown forward, in order to compensate for the brain’s inability to grow on the side that has fused). In looking straight on at the child, the eyebrow on the fused side is usually higher and the upper part of the nose may be off-center, toward the side of the fused suture. Most parents report that their child looks worse when they see their child in a mirror, which may be related to the fact that a mirror flips the image around so the right side becomes the left, etc. Instead of seeing your child as you are used to seeing him or her everyday with the flatness on one side, you now see a “different” child with flatness on the opposite side.

The incidence of plagiocephaly is estimated to be about one in 3500 births. Almost all children affected with plagiocephaly require surgical treatment. The treatment for this condition is discussed in the Treatment section. Also see general information in the Single Sutural Synostoses section.



Sagittal Craniosynostosis (Scaphocephaly)

Scaphocephaly is the term used to describe the shape that results from craniosynostosis, or fusion, of the sagittal suture. This sutures runs from front to back starting at the fontanel (soft spot) at the top of the head, and extends backwards along the middle of the skull. Sometimes the soft spot is absent, or closed. A ridge can be seen, or felt, running along the top of the head in between the right and left halves of the skull. When viewed from above, the skull is wider near the forehead and gets narrower towards the back of the skull (which is the opposite of what is normal: the back of the skull should be wider than the front). When looking straight on at the child’s face, the forehead may seem bigger, and the sides of the skull look narrow.

The incidence of scaphocephaly is one in 2,000 births. It is the most common form of craniosynostosis. Almost all children affected with scaphocephaly require surgical treatment. The treatment for this condition is discussed in the Treatment section. Also see general information in the Single Sutural Synostoses section.



Metopic Craniosynostosis (Trigonocephaly)

Trigonocephaly is the term used to describe the shape that results from craniosynostosis, or fusion, of the metopic suture. The metopic suture runs from the top of the head, at the fontanel or soft spot, down the center of the forehead to the nose. It is different from the other sutures of the skull because it is the only one that normally begins closing in infancy. A ridge can usually be seen running down the center of the forehead and the forehead will look narrow. Often, the eyes are usually spaced closer together than is normal. When viewed from above, the forehead will have a triangular shape, like the bow of a boat.

The incidence of trigonocephaly is somewhere between one in 2,500 to one in 3,500 births. Sometimes it can be very difficult to determine if a child has significant trigonocephaly, or not. Some children who are very mildly affected may not require any treatment. Trigonocephaly has been reported to occur when mothers have taken Valproic Acid (Depakene, Depakote, Convulex) for seizures.

Many children may just have a ridge running down the center of their forehead suggesting that the metopic suture has closed early, however, without producing the triangular-shaped forehead. Only those children who have overt trigonocephaly need treatment. Children with an isolated ridge running down their foreheads do not require surgery (see Publications, Book Chapters #3). The treatment for this condition is discussed in the Treatment section. Also see general information in the Single Sutural Synostoses section.



Lambdoid Craniosynostosis (Posterior Plagiocephaly)

Posterior plagiocephaly is the term used to describe the shape that results from craniosynostosis, or a fusion, of one of the lambdoid sutures. These sutures are located on the back of the skull, with one on the right side and one on the left side, making a shape like an upside down “V.” Usually, only one side fuses shut, but rarely both sides will be closed. When viewed from above, the affected side of the back of the head is flatter than the opposite side. One sign that the lambdoid suture is fused is the presence of a low bump behind the ear, on the same side as the fused suture. Another good way to determine if the lambdoid suture is closed is to check if the ear on the same side as the skull flatness is pulled backwards and, sticks out more. Another sign of lambdoid synostosis is to see if the height of the back of the skull is lower on the flattened side. If the ear is forward on the flat side (with respect to the opposite ear) then a skull deformation should be suspected instead of a fused suture. It is critically important to determine whether or not the child truly has a fused suture because skull deformations almost never need to be surgically treated. There have been a number of articles in the news media about children who were treated surgically for flatness on the back of the head for presumed lambdoid synostosis when, in fact, the child had a deformation and could easily have been treated without surgery (either by doing nothing or by using a headband). Making the diagnosis even more difficult is the fact that on plain skull x-rays, the lambdoid suture can be misdiagnosed as being fused shut. Ideally, the diagnosis of lambdoid synostosis is made by either by an experienced craniofacial surgeon, who can usually tell by an examination alone, or by a CT scan performed at an experienced center. Children, who have lambdoid synostosis and significant flattening of the skull, do require surgery to fix this condition.

The incidence of posterior plagiocephaly is currently unknown and is probably even more rare than one in 50,000 births. The reason that we cannot give an accurate estimate of the incidence of this condition is that it has been over diagnosed in the past. It is probably one of the most rare forms of craniosynostosis treated at busy craniofacial centers. The treatment for this condition is discussed in the Treatment section. Also see general information in the Single Sutural Synostoses section.



Other Synostoses

Sometimes, more than one of these types of single sutural craniosynostosis can occur together in combinations. If both coronal sutures are fused shut, then your child may have a syndrome, sometimes generally referred to as craniofacial dysostosis. For a good starting point, please refer to the sections on Apert, Crouzon, and Pfeiffer syndromes. There are also some even more rare conditions in which multiple sutures are fused in different combinations, sometimes referred to as “complex craniosynostoses.” These rare forms of craniosynostosis are best treated at the busiest national centers.


Treatment



Older Treatments

The earliest treatments for single sutural synostoses were performed by neurosurgeons operating alone. These early procedures, sometimes called “strip craniectomies” or “Pi procedures,” were similar in that they involve removal of the fused suture, in hopes of releasing the restriction to growth (basically, throwing away a section of the skull). However, a number of studies proved that these treatments were almost always unsuccessful. The excised bone usually grows back quickly so that there is no significant change in shape. However, sometimes the skull will grow back incompletely, leaving a permanent open space of unprotected skull. The result is that with these older techniques, the skull shape is never normalized, and sometimes children need to have another operation to either correct the skull shape, or to fill in skull defects that never completely healed in.

Remodeling Procedures

Today, children with a single sutural synostosis usually undergo an evaluation by a craniofacial team prior to deciding on surgical treatment. If needed, surgery is performed by both a craniofacial surgeon and a pediatric neurosurgeon working together (if parents meet a neurosurgeon who recommends operating without a craniofacial surgeon, then I strongly recommend seeking another opinion). Typically, it is the role of the neurosurgeon to safely remove the bone, and the craniofacial surgeon’s job is to rebuild the skull into a normal shape. The specifics of this procedure vary from surgeon to surgeon.

After learning that the “strip procedures” (mentioned above) never completely corrected the abnormal skull shape, craniofacial surgeons recognized that not only is it necessary to remove the bones affected by a fused suture, it is also critical to remodel the skull bones in order to achieve a normal skull shape. These remodeling procedures vary, but there are three basic techniques: 1. Surgery is limited to the area of the skull near the fused suture and is done in a single operation (this is my preference; see “the Dallas Procedure” below). 2. The entire skull is removed, and remodeled in one operation (I think that this bigger operation may add proportionally more of a chance for complications). 3. The skull is treated with two separate operations, one on the back, and then a second one in the front (why double the risks of surgery, when the problem can be fixed with only one operation?).

Endoscopic, or “Minimally Invasive” Procedures

Recently, a few surgical teams have gone back to performing a modification of the older “strip procedure” using an endoscope (operating through a small tube) and then putting a child in a headband for up to a year, in order to mold the desired shape. Some surgeons have used the term “minimally invasive” to describe this procedure. I believe that there is nothing minimally invasive about removing a skull from an infant, and I am concerned that the term “minimally invasive” may be used more as an advertising term, which is misleading. In my opinion, the use of the word “minimal” wrongly suggests to parents that this procedure is a safer operation. In fact, this technique might actually have a slightly higher serious complication rate (and death rate) than a remodeling procedure. One reason for the higher complication rates with “minimally invasive endoscopic” surgery might be because of the limited view that the surgeon has when performing the operation. As a result of the small incisions, the surgeons can only see what is going in by looking through a small tube. This may potentially result in the surgeon not being able to see an area that continues to bleed and should be stopped, or dura (the covering of the brain) that has been accidently torn and needs to be repaired.

In addition to the “minimally invasive” operations probably having a slightly higher complication rate than a remodeling operation, many parents are understandably not happy about the need for their baby to wear a headband for up to a year after the operation. It is important to realize that the endoscopic operation does not significantly correct the abnormal skull shape; it is the head-banding technician who works to mold the skull shape and not the surgeon. The final result is dependant upon the skill of the technician doing the molding, and the ability for the parents to actually keep their child in the headband.

I have seen some children to get a fairly good initial result with an endoscopic repair; however, some children do not end up with a sufficient correction, and must be re-operated on using a remodeling technique. Studies performed at the Dallas Center have shown that if one follows a child’s growth for up to 10 years after correcting sagittal craniosynostosis, growth is not normal and there is a tendency for the skull to go back towards the way it was before the repair (see Publication #25). These new findings suggest that it is very important for the surgeon to over-correct the presenting problem; otherwise, 10 years later, the child may need to undergo a repeat operation. Over-correction is very hard to achieve with an endoscopic repair, and I believe it is likely that we will learn that the need for second operations is going to turn out to be much higher in children repaired endoscopically, once those children treated with this relatively new technique have had a chance to grow up. It is my impression that the younger the child at the time of endoscopic surgery (less than 4-months old), and the less severe the presenting skull shape, the better the result might potentially be, but no one has yet studied this. I believe that parents should only consider the endoscopic technique with very young babies who have sagittal synostosis (because when the child’s skull grows back the way it was, the abnormal skull shape will more likely covered with hair and a second operation would be less likely). Finally, any operation that removes a strip of bone and does not put it back relies upon the ability for the lining of the brain (called the “dura”) to remake new bone to fill in the gaps. If this does not happen completely, then a second operation may likely be needed to reconstruct the missing skull bone.

In conclusion, while the endoscopic procedure is a slightly shorter operation, it is probably a slightly riskier operation, which on average produces a result that is not as good as can be achieved with a remodeling procedure (which at our center, takes about 45 minutes longer in the operating room, and saves months of head banding treatments).

When is the best time to do the operation?

Surgery to correct craniosynostosis can be done at any age. The ideal time is between 4 –10 months, depending on which suture is fused shut.

In favor of the earliest correction are a number of factors:


With early operations the skull is less rigid and easier to shape.
The younger the infant, the better the chance that any small skull defects that might be left at the end of the operation will fill in. After one year of age, babies pretty much lose their ability to make skull bone. So, when operating on an older child, a slightly more extensive operation is necessary in order to fill in all open areas.
The longer a child grows with a fused suture, the more that other areas of the skull may over-expand because the brain cannot grow near the fused suture; this further changes the skull shape in an abnormal way. A study done at our center suggested that for children born with trigonocephaly, surgery before six months of age allowed better growth between the eyes, which is an area abnormally narrowed by the fused metopic suture (see publications #14.)
In favor of operating at a later age are a number of factors:

The operation may be slightly safer. The worst possible complication, following both endoscopic and remodeling procedures, is the baby does not survive the operation. This horrible complication, which is very rare, almost always results from excessive blood loss. As the infant gets bigger, the child has more blood to lose, and there may be a decreasing likelihood that a blood transfusion will be necessary. Surgery before 12 weeks of age is unusual unless the deformity is quite severe. At our center, I routinely give infants a drug called erythropoietin before surgery (see Procrit Information), which typically raises a child’s blood levels to help prevent the need for blood transfusions, hopefully improving the overall safety of the operation (see Publications #19 and #25). I also use a “cell-saver” that sucks up most all of the blood lost during the operation, filters it, and lets us give the baby back it’s own blood. These two different techniques (and many other smaller things that are also done) when combined together make blood transfusions fairly uncommon in my practice. Some research suggests that patients who get blood transfusions are more likely to get infections after surgery.
The other benefit to operating at a later age is that the correction performed is more likely to last a lifetime. Research done in our Dallas Center examined the long-term growth of the skull for over 10 years following correction of sagittal synostosis (see Publications# 25). In one of the first studies of its kind to examine long-term growth after surgical correction, we found that children’s skulls do not grow as they should following the operation (even though the skull shape was completely normalized after surgery); the skull tends to grow back to way it was before the correction. As a result of this research, I have been over-correcting the skull shape for some time, and very few of my patients have needed second operations (less than 2%, thus far). Operating on older children, and over-correcting the skull shape during the operation, probably significantly reduces the chance that a child will need a second operation 10 years or more after the first. Another recent study at our center, yet to be published, shows that the other sutures are similar to the sagittal suture in that growth is not normal after surgery, further supporting the need to over-correct the skull at the time of the operation.


Balancing all of the above factors, it seems that the ideal time to correct craniosynostosis is somewhere between 4 – 10 months, depending on which suture is involved, the severity of the abnormal skull shape, and a number of other factors.

The Dallas Remodeling Procedure.

In my practice, the surgery to correct a single suture craniosynostosis is always performed with both a craniofacial surgeon and a pediatric neurosurgeon, both of whom are present for the entire operation. I believe that having two experienced surgeons always with the child, improves the speed and safety of the operation. In addition, only pediatric anesthesiologist’s with extensive craniofacial surgical experience are typically selected. During the operation, the family is given hourly updates as to their child’s condition. The average correction takes just under four hours from start to finish, although the actual surgical time is much shorter, averaging about an hour and 45 minutes (about half of the total time in the operating room is spent preparing the child for surgery, and then slowly waking the child up). We do not shave any hair for surgery, although many centers still prefer to do so. The surgery is performed though an incision that is made from ear to ear across the very top of the head. Many years ago, I developed a wavy, “zigzag” incision to replace the standard straight-line incision, so that when children get their hair wet it won’t part on a straight-line scar and make the scar obvious (see Publications #10). Recently, I have shortened the length of this incision (starting it well above the ears) so that the scar will be even less noticeable.

The goal of the operation is to remove the areas of skull that were affected by the fused suture and rebuild the skull into a normal shape (which is slightly over-corrected to compensate for the abnormal growth that that will occur). In order to rebuild the skull, it is necessary to somehow hold the bones together, so that they can heal. Most surgeons use plates and screws to set the bones, however, I prefer to use dissolving stitches for a number of reasons. To begin with, after operating on children who had initially undergone surgery at other centers, we discovered that when other surgeons used metal plates and screws to hold the skull bones together, with the subsequent growth of the skull these plates will end up on the inside of the skull with the screws poking into the brain (see Publications #12). Studies elsewhere have noted the same thing happens with some of the dissolving plates and screws: they can also end up inside the skull against the brain before they dissolve. While I am not aware of any cases in which this has caused a problem I have decided to use dissolving stitches to avoid any potential problems (see Publications #20). I have also found that when plates and screws do dissolve, they can end up leaving a weak space inside of the skull bones that can make additional operations (if needed) much more technically difficult. For this reason, I feel fairly strongly that they should be avoided in children with syndromes (who are most likely to need additional operations) such as Apert, Crouzon and Pfeiffer, etc. Finally, in a small percentage of cases, dissolving plates and screws will melt into a liquid that collects in a pocket under the skin, before it opens a hole on the face or scalp and drains out. Given all these potential problems, I am convinced that while it is technically more difficult to use dissolving sutures to rebuild a skull instead of using plates and screws, it is what I would want for my own child.

At the end of the operation, we close the scalp with dissolving stitches. We never use metal staples or non-dissolving sutures, as these can hurt when they are removed. We also do not put any bandages on the child, and do not use any drainage tubes (I believe that these tubes make the recovery actually slightly more complicated). Instead, the child is given a shampoo before we leave the room and the hair is combed over the incision. Many surgeons do like to use head wrap bandages; this is not “wrong” in my opinion, but these head wraps are unnecessary.

The child usually will spend one night in the pediatric intensive care unit and are transferred to the floor the following day. While most of my patients might be ready to leave the hospital in about 24 hours, I recommend all stay for at least two nights total in the hospital. The risks of the surgery are very small at the most experienced centers. In a published report (see Publications #15) looking at a combined experience with our center and one other center, we found that no infections occurred in infants undergoing operations for craniosynostosis (although this is certainly possible).

When craniosynostosis corrections are performed on older children, they tell us that they feel almost no pain (they do say that their skin feels “tight” with the swelling that occurs). Nevertheless, we have a policy of playing soft music in the child’s room after surgery because a study showed that soft music relaxes children, and reduces the amount of pain that a child will report feeling after the operation (it also reduces the amount of pain medicine needed).

If you google cranio kids Did-your-Cranio-Cutie-have-increased-ICP you will see many parents who posted symptoms of intercranial pressure, including one who said blood shot eyes

There is enough information in this to search for it, again I can not post links since I am new

Beitr Gerichtl Med. 1990;48:217-21.
[Premature craniosynostosis--cause of sudden death in children and young adults].
[Article in German]
Rabl W, Tributsch W, Ambach E.
Source
Institut für Gerichtliche Medizin, Universität Innsbruck.
Abstract
Primary premature craniosynostosis ordinarily leads to characteristic skull abnormalities, if the ossification of the sutures happens in early childhood and involves all sutures, the elevation of intracranial pressure may not cause severe clinical features and the head morphology may be normal. A disproportion between skull capacity and brain volume will be the result. Three cases are reported, where these preconditions combined with exterior effects like minimal trauma, physical activity or consumption of alcohol or medicaments caused sudden death. Important autoptic findings are ossified cranial sutures with the absence of suture lines and increased scalloping of the internal table of the skull (impressiones digitatae).


Also....

TomTerrific had posted parts of an article, but not the whole article you can access it by clicking the end.

First he stated

Poster's Note: The conclusions that I am drawing here are that since it was a "single" CS that the risk of increased brain pressure (enough to cause a fatal brain bleed) was extremely small. Had the entire skull been fused the risk would be much higher and probably required surgical intervention. The biggest, and most likely, risk would be psychological or behavioral and that only presents itself in less than 50% case rate.

The article is written by psychologists, not surgeons, they use the term single suture interchangeably with isolated there is some information in the article not totally presented correctly since it is written for the correlation with behavior. Isolated means the only thing the child has is cranio of a single suture, no syndromes or other sutures. Multiple fusion means complex cranio or syndrome present. However a single suture can be syndromic, the coronal suture, ear to ear, is the most often one associated with syndromes, either the right or the left or both. It is not stated anywhere which suture of Colins was fused, if it was evident, it was likely coronal, again just a guess I can not find a clear picture of him, only a video. We do not know if he had just one suture fused or had a syndrome which could have other issues.

Tom stated ( again from above quote)
The conclusions that I am drawing here are that since it was a "single" CS that the risk of increased brain pressure (enough to cause a fatal brain bleed) was extremely small

However this is from HIS article...this is why surgeons push surgery this is why my daughter even after surgery goes to the eye dr every 4-6 months to monitor the optic nerve for pressure In addition, pressure increases in the head (as mentioned in the article) from coughing, vomitting etc...

Intracranial Pressure (ICP)
Elevated ICP is the most frequently cited mediator of the presumed negative effect of suture fusions on brain development (Cohen & Persing, 1998). Elevated ICP is believed to promote hypovascularity in the approximate region of the fused suture, leading to hypoplasia of underlying brain tissue. Clinical formulations often refer to the reduction or prevention of elevated ICP as one of the primary reasons why cranioplastic surgery may reduce the probability of neurodevelopmental delay or deficits in infants with craniosynostosis (e.g., Renier & Marchac, 1988). This hypothesis has been widely communicated to parents, mostly via websites that suggest a causal relation between ICP and subsequent neurobehavioral problems and that surgery may relieve ICP and therefore prevent or lower the risk for “brain damage” and associated neurobehavioral deficits. What is the empirical evidence for such claims, particularly for children having single-suture synostosis?

Thompson et al. (1995) monitored the subdural ICP of 74 children with sagittal, metopic, or unilateral coronal synostosis while they slept. Using a standard criterion for “elevated” ICP (readings above 15 mmHg), they found that nearly half of their sample had normal ICP, over a third had “borderline” readings, and less than 20% had clearly elevated ICP. Among the different types of synostosis, the metopic and sagittal groups had the highest proportions of elevated cases (38% and 24%, respectively). Renier et al. (1982) reported similar findings in their sample of children with single-suture synostosis, using the same criterion for elevation. Few studies have examined associations between ICP and neurobehavioral status. Renier and Marchac (1988) compared the ICP values of children with developmental quotients above and below 90 on standardized cognitive measures. Among the single-suture anomalies included in these analyses (sagittal and unilateral coronal), only those with unilateral coronal synostosis showed the hypothesized inverse relation between cognitive status and ICP; however, it is unclear whether this association was statistically significant (no details of these analyses were reported). Neither Arnaud, Renier, and Marchac (1995) nor Gewalli et al. (2001) found significant associations between ICP and developmental test scores in independent samples of infants with sagittal synostosis.

Cohen and Persing (1998) have discussed the many problems in interpreting ICP data, including the use of differing measurement techniques and patient selection criteria among investigators; and the complete lack of normative data, which are unlikely to become available until there are reliable methods of noninvasive measurement (Mouradian, 1998). In the absence of normative data, the precise threshold for “abnormal” readings is unclear. ICP is also difficult to quantify, as it is a changing value that covaries with an individual’s activities (e.g., coughing or sneezing can produce rapid increases up to 50 or 60 mmHg). ICP therefore needs to be measured over an extended period to obtain a stable representation. The metric most reflective of clinically meaningful intracranial hypertension is still a matter of debate (e.g., mean values or number of elevations above threshold; see Eide, Helseth, Due-Tonnessen, & Lundar, 2002). Cohen and Persing noted the relative infrequency of clinical indicators of increased ICP in cases of single-suture synostosis (e.g., irritability, head banging, retinal changes), even among those with elevated readings. The consequences of elevated ICP in the absence of clinical symptoms are unclear.

Overall, it would appear that the elevated ICP hypothesis is at best modestly supported by available data, with uncertain implications for the causal relation between synostosis and brain growth.

Again he stated in the above quote,
Had the entire skull been fused the risk would be much higher and probably required surgical intervention.

It is EXTREMELY rare for the whole skull to be fused but again from his article I bolded most cases of isolated require surgery

The incidence of an isolated suture fusion is about 1 in 2,000 live births (Shuper, Merlob, Grunebaum, & Reisner, 1985; Singer, Bower, Southall, & Goldblatt, 1999). Sagittal synostosis is believed to be the most common (e.g., 1 in 4,000 births; Lajeunie, LeMerrer, Bonaiti-Pellie, Marchac, & Renier, 1996), although incidence figures for each of the specific suture fusions have varied tremendously (Singer et al., 1999). The majority of single-fusion cases are sporadic, although mutations in the fibroblast growth factor receptor genes have been found in some cases (e.g., Moloney et al., 1997). Most cases of isolated synostosis require a single surgery (cranioplasty) to release the fused suture and reshape the deformed calvaria. Surgery is preferentially performed within the first year of life (typically 3–6 months of age), which capitalizes on the malleability and rapid growth of the infant’s brain and minimizes secondary facial deformation (Marsh, Jenny, Galic, Picker, & Vannier, 1991; Marsh & Vannier, 1986). Surgery before 1 or 2 months of age is rare, due to concerns about blood loss and other survivability factors (Jimenez, Barone, Cartwright, & Baker, 2002).

Again from his quote
The biggest, and most likely, risk would be psychological or behavioral and that only presents itself in less than 50% case rate

Well since this is an article on neurobehavior written by psychologists, what other conclusion would there be? That is what they were investigating. Craniosynostosis is very serious I wish I was allowed to post web links but since I am new I can not. It is hard to understand since many of the medical community do not remember the day that page was covered in medical school. There are many more complications than behavioral like seizures my daughter has had, unexplained fever, eye sight issues,speech issues intercranial pressure being a big one. If ICP was not an issue I would not have subjected my daughter to a 9 hour operation at 5 months of age where they cut her skull, pulled down the skin, removed the front part of her skull, reshaped it and put it back. Her eyes swelled up as if a professional boxer punched her square in both eyes and she could not open them for a week. She was in so much pain she mustered the strength to say her first word momma since she was in so much pain. I am lucky my daughter lived, she had a spinal tap at 3 days because of the emerging signs of ICP (checking for infection) but maybe that is what saved her perhaps that fluid was enough to take the pressure off or maybe it was just a coinincidence.

Here are complications from the Mayo clinic

Babies with craniosynostosis, particularly those with an underlying syndrome, may develop increased pressure inside the skull (intracranial pressure). Their skulls don't expand enough to make room for their growing brains.

If untreated, increased intracranial pressure can cause:

Blindness
Seizures
Brain damage
Death, in rare instances

In addition, facial deformities that affect the middle of your child's face may cause:

Upper airway obstructions, compromising your baby's ability to breathe
Permanent head deformity
Problems with speech and language development
Poor self-esteem

Again in my humble opinion, I think it is entirely possible it was only the cranio which caused the problem. I do not know if he is guilty or not, I am leaning to not. Everything makes sense, he loved his kid, who was only 5 weeks old and he was likely very forceful in administering CPR. If he is guilty I hope they lock him away forever. However, if he is not, I pray the defense understands this rare condition well enough to present it clearly enough to the jury. Should anyone read this I can help direct them to resources and people familiar with this. wpgdesigners at yahoo dot com. Sorry for all the posts. Again i pray Colins soul is at peace, and only he knows what really happened.

To craniomom> No need to apologize for the number of posts. Your thorough analysis, multiple sources and personal experience are very helpful in aiding myself and all of our readers get a better understanding of this rare yet precarious medical condition. I had heard of this before, but only in the abstract. While it is true that I cited only one article, my conclusions were based on that article posted along with others that I had read. I would never pretend to be a doctor, let alone a cranio specialized neurosurgeon. I was only trying to present a synopsis of the medical claims of the state and the defense in this case. Your analysis is much better and more thought provoking. Thanks for helping us understand and we wish you much strength and happiness for your family going forward.

BENNINGTON - The trial of a man accused of killing
his 5-month-old son "in a moment's rage," concluded its second day on
Tuesday with motions by the defense regarding potential character
witnesses and expert testimony.
Russ C. Van Vleck, 28, of Arlington, pleaded not guilty early last year
to one count of manslaughter after the State Medical Examiner ruled the
death of his son, Colin Van Vleck, was the result of a homicide. The
state has accused Van Vleck of violently shaking or throwing the child
against a soft object, causing internal injuries that killed him.

Bennington attorney William Wright, assisted by attorney Joyce Brenner,
are arguing their client's son died of a condition he had at birth that
caused plates in his skull to fuse too early, leading to pressure on the
brain and subsequent death.

Both the state and defense say the trial relies heavily on the testimony
of medical experts. It's been scheduled to last two weeks.

Judge David Howard, after the jury recessed for the day, heard arguments
from Deputy State's Attorney Christina Rainville and Wright on the
admissibility of testimony related to Van Vleck's character. Wright said
some of his witnesses may testify that his client is not prone to
reckless or careless behavior. He said the state hasn't charged Van
Vleck with a specific act, an issue he raised before the trial, and is
charging him with a type of behavior. He said he must be allowed to
defend that accusation.

Rainville said case law prohibits the defense from citing specific acts
that speak to Van Vleck's character, but they can find people in the
community to speak to his general behavior and actions.

Brenner had argued about the state's intention to call Dr. Karyn Patno, a
Burlington pediatrician, saying what the state intends to have Patno
testify on issues that have been raised, or could be addressed, by other
witnesses. She said the state is not allowed to simply put on multiple
experts to strengthen their case through numbers.

Rainville said Patno will speak to specific aspects of the case not
covered by other witnesses, such as Dr. Steven Shapiro, the State
Medical Examiner who performed Colin Van Vleck's autopsy. She said the
defense is also trying to make it so the state relies on witnesses the
defense plans to attack as being unreliable because of the extent of
their medical knowledge.

The jury spent Tuesday listening to the rest of Shapiro's testimony,
along with that of Dr. Bruce Tranmer, a neurosurgeon at Fletcher-Allen
Medical Center. The doctor that oversaw the child's birth at
Southwestern Vermont Medical Center, along with the nurses, were also
called.

On Monday the jury listened to a 911 call made by Van Vleck and hearing testimony from the state medical examiner.

Attorneys in the case have said the trial will make heavy use of expert witnesses and much of the evidence is scientific.

Before the trial began, Brenner, filed a motion to dismiss the case on
the grounds the state hadn't specified what act of Van Vleck's caused
the boy's death. Judge David Howard ruled that that wasn't grounds for
dismissal and could be addressed during jury instructions before
deliberations.

Rainville said the infant had no external injuries or broken bones. She
said he had evidence of hemorrhages in his eyes, areas of his brain,
neck, and spine.

According to Rainville, Shapiro's examination did not find the kind of
blood cells in the hemorrhages and other internal injuries that would be
present as part of the healing process, which she said was an
indication the bleeding occurred not long before the boy's death.

The trial is scheduled for the next two weeks. The trial in Bennington
had been scheduled to begin in June, but last-minute disagreements
between the state and Van Vleck's defense team over some of the experts
who would be testifying delayed the trial for a few months.
http://www.manchesterjournal.com/headlines/ci_19148464

Trial of man charged with killing son will continue on Monday

KEITH WHITCOMB JR.
Posted: 10/21/2011 12:08:12 AM EDT

Thursday October 20, 2011
BENNINGTON -- The trial of an Arlington man accused of causing the death of his infant son in 2009 will resume on Monday.

Russ C. Van Vleck, 28, is charged with one count of manslaughter. A state medical examiner ruled the 5-week old child's death the result of a homicide, something Van Vleck's attorney is contesting by saying the internal injuries were caused by a condition the boy had at birth that involves skull plates fusing prematurely and putting pressure on the brain.

The state, meanwhile, has contended the injuries are more consistent with the infant being shaken or thrown.

Friday is a pre-scheduled furlough day for Vermont courts. They were implemented by the judiciary to deal with budget woes. The trial began Monday and as expected has made heavy use of expert witnesses in addition to medical professionals involved with the case.

Recorded interviews between Sgt. Robert Patten of the Vermont State Police and Van Vleck were played for the jury. The emergency technicians who responded to Van Vleck's 911 call two years ago were also called as witnessed.

The state also called pediatrician Karyn Patno as an expert on child abuse. Attorney Joyce Brenner, who is assisting Van Vleck's attorney William Wright, questioned Patno's status as an expert on child abuse trauma, which Patno testified wasn't a recognized specialty within pediatrics until 2009. She testified she'd undergone a 6-month version of a 2-year fellowship on the specialty, but prior to 2009 child abuse was considered part of the pediatric discipline.
Judge David Howard ruled Patno had shown she was qualified to be an expert witnesses.

The proceedings have been starting around 8:30 a.m. and running until about 4 p.m. Howard reminded jurors they're not to speak about the case outside of court, even to each other, and said they must take special care to avoid talking about it on the long weekend. They've also been cautioned to avoid media reports on the trial, which is expected to last much of next week.

http://www.benningtonbanner.com/local/ci_19160500

Van Vleck defense team opens case

Wednesday October 26, 2011
KEITH WHITCOMB JR.

BENNINGTON -- Defense attorneys for an Arlington man accused of killing his 5-week-old son began establishing their case Wednesday, and the trial is expected to continue into early next week.

Russ C. Van Vleck, 28, pleaded not guilty in 2010 to a charge of manslaughter after the Vermont State Medical Examiner's Office ruled his son's October 2009 death to be a homicide. The state finished with its witnesses Wednesday morning, while attorney William Wright, who represents Van Vleck, called Dr. Ronald Uscinski, a nuerosurgeon from the Baltimore area, to provide a counter to the state's expert witnesses.

Wright said Uscinski testified that Colin R. Van Vleck, the deceased infant, did not die from being shaken, thrown into a soft object, or from a non-accidental injury, but died from a combination of a birth injury and a skull defect.

It's been the state's position, backed up by Chief Medical Examiner Steven Shapiro and Dr. Elizabeth Bundock, a neuropathologist at the State Medical Examiner's Office, that the infant was killed by being shaken or thrown into a soft object. The state has said the internal bleeding, in addition to other injuries, along with there being no external injuries on the child's body, implicate Van Vleck, as he was the only one with the child the night of the death. He was the one who called 911, saying Colin Van Vleck wasn't breathing.

Wright said Uscinski supports the defense's position that the boy was born with some difficulty, and that it caused bleeding in his brain. Colin Van Vleck was also born with plates in his skull fused together.
Normally, when a child is born the plates in the skull are able to shift to accommodate both being born and the brain's subsequent growth. Wright and attorney Joyce Brenner, who is assisting him, are working to lay a case that says pressure built up in the baby's skull, causing a host of problems that explain his internal injuries and some of his behavior in the days before his death.

Deputy State's Attorney Christina Rainville has had experts testify that there's no recorded case of the type of plate fusing Colin Van Vleck had causing an infant's death, and that he had a stomach virus not long before he died that accounted for his fussiness and vomiting, which she said is not because of "intracranial pressure."

Wright said he plans to call two medical examiners from the Miami-Dade County (Fla.) Medical Examiner's Office to testify in addition to Uscinski, who concluded his testimony late Wednesday.

The trial began Oct. 17 and was scheduled to run for two weeks, but Judge David Howard informed jurors that it may stretch into Nov. 1. He said it's also possible the trial may be in session Saturday morning, although that won't be determined until today.

There are four alternate jurors. Two had mentioned they may have scheduling issues early next week, while another indicated Saturday might be difficult to make time for.

Wright said the number of expert witnesses called and their scheduling issues have contributed to the pace of the trial, and that was somewhat expected.

http://www.benningtonbanner.com/local/ci_19201793

Defense expert witnesses testify in Van Vleck trial

KEITH WHITCOMB JR.
Posted: 10/28/2011 10:59:09 PM EDT

Friday October 28, 2011
BENNINGTON -- Expert witnesses for the defense concluded their testimony Friday in the trial of a man accused of causing the death of his 5-week-old son in 2009.

Russ C. Van Vleck, 28, of Arlington, pleaded not guilty last year to one count of manslaughter. His trial began Oct. 17 and was expected to run for at least two full weeks.

Judge David Howard told jurors Friday after calling a recess that it’s likely the trial will go until at least Tuesday, and to not make plans for Wednesday. He said he does not want jurors starting deliberations at the end of a long day.

The case has relied heavily on expert witnesses. The state has called doctors from the Vermont Medical Examiners Office who performed the autopsy on Colin R. Van Vleck, as well as Burlington-area pediatricians.

Bennington attorney William D. Wright, who represents Van Vleck, has called experts from the Baltimore, Md., area as well as two pathologists from the Miami-Dade County (Fla.) Medical Examiners Office. He said he will now move into calling "fact witnesses" and will determine who that will be over the weekend.

The last person to testify Friday was Benjamin Corcoran, who lived in Arlington for over 20 years and is friends with Van Vleck. He said Van Vleck has a reputation in town as being "peaceable" and "meticulous."

It’s the state’s contention that one October night in 2009, while he was alone with his son, Van Vleck either shook the infant or threw him into a soft object causing internal injuries which led to his eventual death. He then called 911 and was coaxed through CPR until paramedics arrived. The infant died some hours later at the hospital.
The defense’s case has been that Colin Van Vleck died of a combination birth injury and birth defect. The injury, bleeding in the brain, caused the organ to swell, while a defect had caused two plates on his skull to fuse prematurely, thus not giving the brain room to expand.

Wright said Friday there hasn’t been much disagreement between experts on the evidence itself, but they don’t see eye to eye on what the findings mean or what caused the infant’s death.

http://www.benningtonbanner.com/local/ci_19219556

Jury deliberations set to begin today in Van Vleck case

Posted: 10/31/2011 10:54:57 PM EDT

KEITH WHITCOMB JR.

Staff Writer

BENNINGTON -- Jurors who’ve heard evidence for the past two weeks in an infant death trial will get their instructions today and are expected to begin deliberations.

Russ C. Van Vleck, 28, of Arlington, pleaded not guilty last year to manslaughter, a charge stemming from the October 2009 death of his 5-week-old son, Colin R. Van Vleck, which the State Medical Examiner’s Office ruled a homicide.

The defense concluded its case Monday, and the state’s rebuttal testimony from an expert witness at the medical examiner’s office was short. Judge David Howard decided to recess in the early afternoon, as closing arguments plus jury instructions would have jurors beginning deliberations in late afternoon or early evening, something Howard wished to avoid given the complex nature of the case.

Both the state and Van Vleck’s attorneys have made heavy use of expert witnesses, who have testified to the meaning behind the medical examiner’s findings. Deputy State’s Attorney Christina Rainville has argued the infant’s injuries could only be the result of being shaken or thrown into a soft object, and has called the chief medical examiner, members of the ME’s office, and Burlington-area neurosurgeons and pediatricians to testify.

Bennington attorney William D. Wright called a Baltimore-area nuerosurgeon, plus two pathologists from the Miami-Dade County (Fla.) Medical Examiner’s Office to testify in support of the scenario they’ve put before the jury to explain the infant’s death.
Wright has argued that Colin Van Vleck had a brain injury when he was born, which coupled with a birth defect causing two plates in his head to fuse prematurely, caused him to stop breathing. Normally, the plates in infant skulls aren’t fused, allowing the brain to expand and the skull to contract during birth, but two of the infant’s skull plates weren’t free to do this.

The defense has said these two things caused pressure to build inside the boy’s skull, accounting for his other internal injuries as well as some of his behavior beforehand. It was reported to police that Colin Van Vleck had been vomiting and was fussy, signs the defense has said are symptoms of pressure inside the skull.

The state has argued a stomach "bug" the infant was recovering from account for the vomiting and fussiness, and have had experts testify that the level of pressure needed for death would cause more than fussiness and vomiting.

There’s been little disagreement on what evidence has been presented, but the interpretations by experts have been different. Friends, family, police, doctors, and emergency medical technicians have all testified in the case as to what happened the last day the infant was alive.

http://www.benningtonbanner.com/news/ci_19235962

Van Vleck jury struggling with deadlock

Posted: 11/01/2011 10:09:55 PM EDT

KEITH WHITCOMB JR.

Staff Writer

BENNINGTON -- After announcing Tuesday evening that it was deadlocked, the jury in an infant death case will reconvene this morning in an attempt to reach a verdict.

On trial is Russ C. Van Vleck, 28, of Arlington, who in March 2010 pleaded not guilty to manslaughter. The Vermont State Medical Examiner’s Office ruled his 5-week-old son’s October 2009 death to be the result of a homicide.

The jury got the case at 1:30 p.m., after hearing closing arguments from both the prosecution and defense attorneys. At 7:25 p.m., they announced they were deadlocked and both the state and defense discussed with Judge David Howard the possibility of a hung jury.

Before the deadlock could be addressed, the jury sent out notes asking to hear playback of the testimony given by Dr. Kenneth Hutchins, a pathologist at the Miami-Dade County (Florida) Medical Examiner’s Office, who’d been called by the defense as an expert witness to refute the state’s own experts.

The testimony in its entirety is roughly three hours long, and it was decided between the jury, the court and attorneys that jurrors would come back at 8:30 a.m. to listen to it.

The trial began on Oct. 17 with the state presenting evidence suggesting Colin C. Van Vleck, the infant, died from injuries he could only have received from his father on Oct. 2, 2009, by either being shaken or thrown into a soft object.
The defense has presented experts who examined the infant’s remains and suggested Colin Van Vleck died from two things working together, one being an injury at birth that caused his brain to swell, and a birth defect that fused two of his skull plates together, thereby not allowing the brain room to expand and killing him.

Earlier in the day, Deputy State’s Attorney Christina Rainville said in her closing arguments that when people recall a traumatic event, they can do so with clarity. She said Van Vleck gave conflicting statements as to the events of Oct. 2, 2009, giving different time intervals between when he set the baby to sleep and when he noticed he wasn’t breathing.

She also said Van Vleck told different stories about where he put the baby, on the bed or the couch, and said different things about what he’d been doing while Colin Van Vleck slept, playing a video game versus watching a movie.

She said Russ Van Vleck allowed investigators to take photographs of himself performing CPR on a baby doll in the same manner he did with his son. She said the seven photos are "seven lies," and that he held the doll in such a way as to explain the internal injuries.

Rainville said there were "axonal balls" found in the child’s spine. Axons are microscopic fibers found in the spine and brain that work like conveyer belts moving proteins. When they break, the conveyer mechanism keeps working and material piles up at the broken ends forming balls.

She said one of the state’s experts, Dr. Bruce Tranmer, a neurosurgeon at Fletcher-Allen Health Care with 30 years of experience, testified that trauma causes axons to sever.

Rainville said pressure inside the infant’s skull doesn’t account for the injuries like a detached retina (in the eye) and hemorrhages in his neck muscles. She said that even the defense’s experts agreed that there has been no documented case or study showing a child having died of intracranial pressure caused by a single suture craniosynostosis.

She said a child with the level of intracranial pressure needed to cause the damage Colin Van Vleck exhibited would not have been seen in an attentive, healthy child as the infant was reported to be earlier. She said experts testified that if the child were conscious, he’d have been in agony, blind, and unable to move.

Vleck was represented by Bennington attorney William D. Wright, who was assisted by attorney Joyce Brenner.

Wright, in his closing, said the case keys around the standard of reasonable doubt, and he criticized the Vermont Medical Examiner’s Office, referring to Chief Medical Examiner Dr. Steven Shapiro as a "zealot" who first came to a conclusion then looked for evidence to support it.

Wright said the fact there is disagreement among experts shows the "shaken baby" theory is at least still being debated.

"The state wants you to convict when all the experts can’t agree," Wright said. "All the child abuse zealots, they have had to give up the term ‘shaken baby.’ They now call it ‘accidental trauma.’"

He said that had Colin Van Vleck’s death been in Miami-Dade County, it would not have been ruled a homicide. "Who did the research before they came to an opinion?" he asked. "Not Dr. (Karyn) Patno, not Dr. Shapiro, not Dr. Tranmer. We know Dr. (Elizabeth) Bundock did a lot after. They went looking for what they wanted to find."

Patno is a pediatrician from northern Vermont and Bundock is a nuerosurgeon at the Vermont Medical Examiner’s office. All were experts called by the state.

Wright suggested the work by the state medical examiner was "sloppy" and the state’s experts didn’t expect their work to be reviewed by Florida pathologists, who Wright said found things they missed such as indications of a lung problem in the infant.

He countered an inference by the state that Wright’s experts get paid to testify in infant death cases. Wright said they are professionals and are being paid for their expertise, but their motives are just.

Rainville had pointed out, both in her closing and rebuttal, that Dr. Ronald Uscinski, a Maryland-area nuerosurgeon and the first expert Wright called, has made over $1 million testifying as an expert in similar cases, claiming "shaken baby syndrome" requires a broken neck.

Wright said in the days before Colin Van Vleck died he was exhibiting a number of signs that something was wrong. He said his head was misshapen, and that he was fussy and vomiting, things his parents and Dr. Michael Welther, who treated the infant, thought were because of a stomach bug he’d caught from Lindsay Van Vleck, his mother.

"The evidence the defense has advanced shows Colin (Van Vleck) died from a perfect storm of medical events that started before his birth," Wright said.

He said the boy showed signs he was suffering from intracranial pressure and that the Van Vlecks did their due diligence in getting him medical help. "They were looking for answers and they got nothing. (Van Vleck) and his family were betrayed by the medical professionals in Vermont."

Wright said the state has not been able to show Van Vleck caused the death of his son. The medical findings don’t point to that, he said, and there was a lack of findings that would, such as external injuries. He said experts have disagreed on the presence of axonal retraction balls in the child’s spine, and said the state is relying on things Van Vleck told other people to say he doesn’t have his story straight, in effect playing the "telephone game."

He said he had also been sedated when being interviewed by state police in a recording Wright played during his closing arguments and the trial itself.

Van Vleck did not testify, but in the recording, he gives great detail on his child’s eating and sleeping habits and appeared to become emotional when talking about the CPR he gave with coaching from a 911 operator.

He said the method they had him use was different than what he’d learned in the National Guard, and it seemed like he was doing it too slow. "I felt like I ate up 10 minutes of his life by not being able to do the CPR right for him," Van Vleck said in the recording. "I just wanted to get him to somebody who knew what they were doing."

Wright said the evidence shows Van Vleck is a meticulous man who cared for his son and wanted to spend time with him before being deployed.

"They can’t tell you what (Van Vleck) did, all they can do is call him a liar because it suits their purposes," Wright said.

http://www.benningtonbanner.com/ci_19243378?source=most_viewed