Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The object of this study was to clarify whether improved developmental attainment following surgical correction of sagittal synostosis (SS), previously identified at initial postoperative assessment, is maintained at longer-term follow-up at 5 years of age.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The study involved 32 children with SS who underwent corrective surgery at a mean (± SD) age of 8.5 ± 7.25 months (range 2.8–39.9 months). All the children were assessed preoperatively, at 7 months postoperatively, and at 5 years of age, using the Griffiths Mental Development Scales. A control group consisted of 23 children with SS who had received developmental assessment on 2 or more occasions without surgical intervention (8 of these children had had follow-up at 5 years of age).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The data indicated that, prior to surgical correction, children with SS had poorer Gross Locomotor function than other areas of development and that, following surgical intervention, the deficit resolved (even where there was severe developmental delay). The results further showed that improvement in Gross Locomotor function observed at 7 months postoperatively was further improved upon by 5 years of age. The same was true for their overall General Quotient, even in those children exhibiting severe developmental delay. Lesser improvements across time were shown for other skill areas. The children with SS who did not undergo surgery did not show any improvement in development, and in fact a deterioration in fine locomotor control was identified in these patients.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results of this study suggest that corrective surgery for SS has a positive early impact on development, which is maintained and improved upon by 5 years of age, and that this surgery therefore offers more than simply a cosmetic improvement. Furthermore, the results suggest that not operating on children with SS means not only that this opportunity for developmental gain is missed, but that it may also cause an actual deterioration in developmental attainment.</jats:p></jats:sec>

Long-term developmental follow-up in children with nonsyndromic craniosynostosis

“…The current data are consistent with the literature and also with our earlier findings of specific areas of locomotor difficulty at younger ages (Bellew et al 4,5 ). These earlier data indicated that children with SS have significantly poorer gross locomotor function than the normal controls.…”

Language, learning, and memory in children with and without single-suture craniosynostosis

“…Given the mixed findings from previous studies, 4,6,9,12,13,15,23,34,41,48 the primary aim of this investigation was to determine whether school-age children with SSC, all of whom underwent cranioplasty, have deficits in language and memory skills in relation to demographically similar children without a craniofacial disorder. Use of a control group for such comparisons is critical but has been rarely undertaken in previous research on this topic.…”

“…As such, the study's design is limited in its ability to elucidate the mechanisms by which SSC or factors associated with SSC (e.g., surgery and anesthesia exposure 35 ) have led to the group differences observed here and elsewhere. 4,6,9,13,15,23,34,41,48 The etiology of the neurodevelopmental consequences and correlates of SSC remains unclear, with some hypotheses focusing on the effects of the fused suture on brain development [1][2][3]47,49 and others emphasizing preexisting neuropathology that may affect both brain and cranium. 5,19 These studies provide some evidence that changes in brain morphology present prior to surgery persist after surgery.…”

Cranial Ultrasound as a First-Line Imaging Examination for Craniosynostosis

“…Although an isolated single cranial suture closure usually causes only cosmetic deformity, 1 poor gross motor function and learning difficulties resulting from even a single suture synostosis have been reported. [4][5][6][7] Multiple suture synostosis, usually syndromic, has been associated with several complications, such as increased intracranial pressure, headaches, and delayed neurodevelopment. 8 The initial imaging study for infants with suspicion of this condition is generally 4-view radiography [9][10][11][12][13] followed by computed tomography (CT) in cases of positive or equivocal findings at radiography.…”