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Spazzapan P, Velnar T. Isolated Sagittal Craniosynostosis: A Comprehensive Review. Diagnostics (Basel) 2024; 14:435. [PMID: 38396475 PMCID: PMC10887665 DOI: 10.3390/diagnostics14040435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is characterised by a pronounced head shape, often referred to as scaphocephaly. Asymmetry of the face and head, protrusion of the fontanel, and increased intracranial pressure are common clinical manifestations. Early recognition of these features is crucial for early intervention, and understanding the aetiology is, therefore, essential. Although the exact cause remains unclear, genetic factors are thought to play an important role. Mutations in genes such as FGFR2 and FGFR3, which disrupt the normal development of the skull, are suspected. Environmental factors and various insults during pregnancy can also contribute to the occurrence of the disease. An accurate diagnosis is crucial for treatment. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and three-dimensional reconstructions play a crucial role in visualising the prematurely fused sagittal suture. Clinicians also rely on a physical examination and medical history to confirm the diagnosis. Early detection allows for quick intervention and better treatment outcomes. The treatment of sagittal craniosynostosis requires a multidisciplinary approach that includes neurosurgery, craniofacial surgery, and paediatric care. Traditional treatment consists of an open reconstruction of the cranial vault, where the fused suture is surgically released to allow normal growth of the skull. However, advances in minimally invasive techniques, such as endoscopic strip craniectomy, are becoming increasingly popular due to their lower morbidity and shorter recovery times. This review aims to provide a comprehensive overview of sagittal craniosynostosis, highlighting the aetiology, clinical presentation, diagnostic methods, and current treatment options.
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Affiliation(s)
- Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Alma Mater Europaea ECM, 2000 Maribor, Slovenia
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Franco-Mesa C, Shah NR, Konofaos P. Sagittal Craniosynostosis: Treatment and Outcomes According to Age at Intervention. J Craniofac Surg 2024; 35:67-71. [PMID: 37772869 DOI: 10.1097/scs.0000000000009752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/30/2023] Open
Abstract
The purpose of this study is to describe the treatment strategies and outcomes of nonsyndromic single-suture sagittal craniosynostosis based on the patient's age at intervention. Studies from MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched for patients with nonsyndromic single-suture sagittal craniosynostosis. Inclusion criteria encompassed studies with follow-up of at least 12 months, minimum of 25 patients per cohort, and first-time surgical intervention. The risk of bias in nonrandomized studies of intervention tool [Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I)] was applied. A total of 49 manuscripts with 3316 patients met criteria. Articles were categorized based on age at intervention; 0 to 6, older than 6 to 12, and older than 12 months. Fifteen of the manuscripts described interventions in more than 1 age group. From the 49 articles, 39 (n=2141) included patients 0 to 6 months old, 15 (n=669) discussed patients older than 6 to 12 months old, and 9 (n=506) evaluated patients older than 12 months old. Follow-up ranged from 12 to 144 months. Over 8 types of open surgical techniques were identified and 5 different minimally invasive procedures were described. Minimally invasive procedures were exclusively seen in the youngest patient cohort, while open cranial vault reconstructions were often seen in the 2 older cohorts. Endoscopic surgery and open conservative procedures are indicated for younger patients, while complex open cranial vault reconstructions are common in older patients. However, there is no consensus on one approach over the other. Even with the analysis of this review, we cannot factor a strong conclusion on a specific technique.
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Affiliation(s)
| | - Nikhil R Shah
- Division of General Surgery, University of Texas Medical Branch
| | - Petros Konofaos
- Division of Plastic and Reconstructive Surgery, University of Texas Medical Branch, Galveston, TX
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Elevated Intracranial Pressure in Patients with Craniosynostosis by Optical Coherence Tomography. Plast Reconstr Surg 2022; 149:677-690. [PMID: 35041630 DOI: 10.1097/prs.0000000000008821] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Craniosynostosis may lead to elevated intracranial pressure, which may be implicated with impaired neurocognitive development. However, accurately measuring intracranial pressure is challenging, and patterns in craniosynostosis patients are poorly characterized. Spectral-domain optical coherence tomography may enable noninvasive assessment of intracranial pressure in pediatric patients with craniosynostosis. METHODS Pediatric patients with craniosynostosis undergoing surgical intervention between 2014 and 2019 prospectively underwent optical coherence tomographic evaluation. Intracranial pressure was directly measured intraoperatively in a subset of cases. Optical coherence tomographic parameters were compared to directly measured intracranial pressure and used for pattern assessment. RESULTS Optical coherence tomography was performed in 158 subjects, among which 42 underwent direct intracranial pressure measurement during an initial cranial procedure. Maximal retinal nerve fiber layer thickness, maximal retinal thickness, and maximal anterior projection optical coherence tomographic parameters were positively correlated with intracranial pressure (p ≤ 0.001), with all parameters showing significantly higher values in patients with intracranial pressure thresholds of 15 mmHg (p < 0.001) and 20 mmHg (p ≤ 0.007). Patients with maximal retinal nerve fiber layer thickness and maximal anterior projection exceeding set thresholds in optical coherence tomography of either eye demonstrated 77.3 percent sensitivity and 95.0 percent specificity for detecting intracranial pressure above 15 mmHg, and 90.0 percent sensitivity and 81.3 percent specificity for detecting intracranial pressure above 20 mmHg. Patients with associated syndromes or multiple suture involvement and patients aged 9 months or older were significantly more likely to have elevated intracranial pressure above 15 mmHg (p ≤ 0.030) and above 20 mmHg (p ≤ 0.035). CONCLUSIONS Spectral-domain optical coherence tomography can noninvasively detect elevated intracranial pressure in patients with craniosynostosis with reliable sensitivity and specificity. This technology may help guide decisions about the appropriate type and timing of surgical treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, I.
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Osborn AJ, Roberts RM, Dorstyn DS, Grave BG, David DJ. Sagittal Synostosis and Its Association With Cognitive, Behavioral, and Psychological Functioning: A Meta-analysis. JAMA Netw Open 2021; 4:e2121937. [PMID: 34515785 PMCID: PMC8438597 DOI: 10.1001/jamanetworkopen.2021.21937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Findings on the cognitive, behavioral, and psychological functioning of individuals with sagittal synostosis (SS) are highly disparate, limiting their clinical utility. OBJECTIVE To identify and review research on individuals with SS and to determine whether, and to what extent, they experience cognitive, behavioral, and psychological difficulties compared with their healthy peers or normative data for each measure. DATA SOURCES PubMed, Scopus, Embase, and PsycINFO were searched through January 2021 with no date restrictions. Scopus citation searches and manual checks of the reference lists of included studies were conducted. STUDY SELECTION Studies included participants of any age who had received a diagnosis of single-suture (isolated or nonsyndromic) SS or scaphocephaly and who had been assessed on cognitive, behavioral, and psychological outcomes. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 reviewers. Case-control outcomes (individuals with SS vs healthy peers or normative data) were compared using random-effects models with 3 effect sizes calculated: weighted Hedges g (gw), odds ratios (ORs), and mean prevalence rates. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. MAIN OUTCOMES AND MEASURES Findings were categorized by surgical status (conservatively managed, presurgery, postsurgery, or combined); domain (eg, general cognition); type of cognitive, behavioral, or psychological measure (objective or subjective); and source of comparison data (peers or normative data). RESULTS Data from 32 studies, involving a pooled sample of 1422 children and adults with SS (mean [SD] age at assessment, 5.7 [6.6] years; median [interquartile range] age, 3.3 [0.5-10.3] years), were analyzed. Data on sex were available for 824 participants, and 642 (78%) were male. Individual study results varied substantially. Objective tests identified significant moderate group differences on 3 of 16 examined domains: presurgical motor functioning (3 studies; gw = -0.42; 95% CI, -0.67 to -0.18; P < .001), postsurgical short-term memory (2 studies; gw = -0.45; 95% CI, -0.72 to -0.17; P < .001), and postsurgical visuospatial ability (6 studies; gw = 0.31; 95% CI, 0.18 to 0.44; P < .001). Prevalence estimates and ORs varied widely, with 15 studies showing prevalence estimates ranging from 3% to 37%, and 3 studies showing ORs ranging from 0.31 (95% CI, 0.01 to 6.12) for processing speed in the conservatively managed sample to 4.55 (95% CI, 0.21 to 98.63) for postsurgical visuospatial abilities. CONCLUSIONS AND RELEVANCE In this meta-analysis, findings for the functioning of participants with SS were highly disparate and often of low quality, with small samples sizes and control groups rarely recruited. Nonetheless, the findings suggest that some individuals with SS experience negative outcomes, necessitating routine assessment.
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Affiliation(s)
- Amanda J. Osborn
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M. Roberts
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Diana S. Dorstyn
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ben G. Grave
- Craniofacial Australia, North Adelaide, South Australia, Australia
| | - David J. David
- Craniofacial Australia, North Adelaide, South Australia, Australia
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Roy T, Chavez J, R Reid R. Skin Deep: Perception of Scars After Cranial Vault Reconstruction. Cleft Palate Craniofac J 2020; 58:1376-1381. [PMID: 33375823 DOI: 10.1177/1055665620984349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Children with craniosynostosis are vulnerable to stigmatization and social withdrawal. Cranial vault reconstruction (CVR) results in large bicoronal scars, which may trigger further insult to self-esteem and social outcasting. This study aimed to delineate determinants of patient scar self-consciousness, parental scar satisfaction, and parent satisfaction with their child's overall medical/surgical care. METHODS A 14-item questionnaire was distributed to parents of 95 patients who underwent open CVR at our institution. Age at first surgery, race, hair type, typical style, number of surgeries, complications, and use of distractors were surveyed. Patient scar self-consciousness, parental scar satisfaction, and parent satisfaction with their child's overall medical/surgical care were also queried. T tests and linear regressions were performed for binary and continuous variables, respectively. RESULTS Of 45 respondents, significant associations were found between: (1) complications and decreased parent scar satisfaction; (2) complications and decreased overall satisfaction with medical/surgical care, and (3) older age at time of initial surgery and decreased overall medical/surgical satisfaction. A significant association was found between parental scar satisfaction and overall medical/surgical satisfaction (β = 0.65, P = .002). There was no significant association between parent scar satisfaction and parental-reported patient self-consciousness, or parental-reported patient self-consciousness and overall medical/surgical satisfaction. CONCLUSIONS Our results underscore the value of scar aesthetics in reconstructive goals. Advanced age and complications are important determinants of satisfaction. However, the lack of association between parent-reported patient self-consciousness and parental scar satisfaction suggests differences in aesthetic priorities between parents and children. Further studies may elucidate additional aesthetic considerations of CVR in ethnic/racial minorities.
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Affiliation(s)
- Tulsi Roy
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Julia Chavez
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Russell R Reid
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
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Dias MS, Samson T, Rizk EB, Governale LS, Richtsmeier JT. Identifying the Misshapen Head: Craniosynostosis and Related Disorders. Pediatrics 2020; 146:peds.2020-015511. [PMID: 32868470 DOI: 10.1542/peds.2020-015511] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric care providers, pediatricians, pediatric subspecialty physicians, and other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and deformational processes. The purpose of this clinical report is to review the characteristic head shape changes, as well as secondary craniofacial characteristics, that occur in the setting of the various primary craniosynostoses and deformations. As an introduction, the physiology and genetics of skull growth as well as the pathophysiology underlying craniosynostosis are reviewed. This is followed by a description of each type of primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, and frontosphenoidal) and their resultant head shape changes, with an emphasis on differentiating conditions that require surgical correction from those (bathrocephaly, deformational plagiocephaly/brachycephaly, and neonatal intensive care unit-associated skill deformation, known as NICUcephaly) that do not. The report ends with a brief discussion of microcephaly as it relates to craniosynostosis as well as fontanelle closure. The intent is to improve pediatric care providers' recognition and timely referral for craniosynostosis and their differentiation of synostotic from deformational and other nonoperative head shape changes.
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Affiliation(s)
- Mark S Dias
- Section of Pediatric Neurosurgery, Department of Neurosurgery and
| | - Thomas Samson
- Division of Plastic Surgery, Department of Surgery, College of Medicine and
| | - Elias B Rizk
- Section of Pediatric Neurosurgery, Department of Neurosurgery and
| | - Lance S Governale
- Lillian S. Wells Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Joan T Richtsmeier
- Department of Anthropology, College of the Liberal Arts and Huck Institutes of the Life Sciences, Pennsylvania State University, State College, Pennsylvania; and
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Abstract
The purpose of this study was to investigate the prevalence of neurodevelopmental delay among deformational plagiocephaly (DP) children, and to confirm relationship between neurodevelopmental delay and severity of DP.This study is retrospective study. Five hundred thirteen children who visited for abnormal head shape through outpatient department were recruited. To identify the children with neurodevelopmental delay among the 513 children with DP, Denver Development Screening Test (DDST) was performed in 38 children who suspected of neurodevelopmental delay. Cranial vault asymmetry (CVA) was measured by using caliper, and cranial vault asymmetry index (CVAI) was calculated. Thirty eight children with DP who conducted DDST were divided into 2 groups according to the degree of CVA; group 1 included 21 children with CVA under 10 mm, and group 2 included 17 children with CVA over 10 mm.There was a significant difference in number of neurodevelopmental delay between group 1 (n = 7) and group 2 (n = 14) (P < .05). Mean grade of DP, CVA, and CVAI (1.76 ± 0.44, 5.90 ± 2.21 mm, 4.20 ± 1.51%) in group 1 was smaller than that in group 2 (3.41 ± 0.8, 12.71 ± 3.22 mm, 8.83 ± 2.18%), respectively (P < .05).Our results found that the frequency of developmental delay was significantly increased in children with CVA more than 10 mm. Doctors who take care of children with DP had better keep developmental delays in mild.
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Affiliation(s)
- Dong Han Kim
- Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
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Language Development, Hearing Loss, and Intracranial Hypertension in Children With TWIST1-Confirmed Saethre-Chotzen Syndrome. J Craniofac Surg 2019; 30:1506-1511. [PMID: 31299755 DOI: 10.1097/scs.0000000000005241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Saethre-Chotzen syndrome (SCS) is an autosomal dominant condition defined by mutations affecting the TWIST1 gene on chromosome 7p21.1. Previous research has identified an elevated prevalence of intracranial hypertension and hearing impairment associated with this syndrome. This study aimed to investigate the influence of hearing history and presence of intracranial hypertension on language development in children with SCS.A retrospective study note analysis was performed for all patients with a confirmed TWIST1 gene abnormality who attended the Oxford Craniofacial Unit and underwent a language assessment over a 22-year period. Intracranial pressure monitoring, hearing status, and language outcomes were examined in detail.Thirty patients with genetically confirmed SCS and language assessment data were identified. Twenty-eight patients underwent surgical intervention; 10 presented with intracranial hypertension (5 prior to, and 5 after primary surgical intervention). Language data coinciding with the presentation of intracranial hypertension were available for 8 children. About 44% of children with intracranial hypertension presented with concurrent receptive and expressive language delay (n = 4/8). For both children (n = 2) with longitudinal language data available, the onset of intracranial hypertension reflected a concurrent decline in language skills. Audiometric data were available for 25 children, 80% (n = 20/25) had a history of hearing loss. About 50% of these had confirmed conductive hearing loss with middle ear effusion and the other 50% had presumed conductive hearing loss with middle ear effusion. About 100% of the children with available hearing data in our study had evidence of middle ear effusion in at least 1 ear. Results also indicated that 43% (n = 13/30) of the children presented with receptive and/or expressive language delay during childhood.Given the importance of hearing for language development and the preliminary findings of a potential decline in language skills in children during periods of intracranial hypertension, regular follow-up of hearing, language, and intracranial hypertension are indicated in children with SCS.
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Di Rocco F, Gleizal A, Szathmari A, Beuriat P, Paulus C, Mottolese C. Sagittal suture craniosynostosis or craniosynostoses? The heterogeneity of the most common premature fusion of the cranial sutures. Neurochirurgie 2019; 65:232-238. [DOI: 10.1016/j.neuchi.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
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Caregiver stress in children with craniosynostosis: a systematic literature review. Childs Nerv Syst 2019; 35:217-225. [PMID: 30155782 DOI: 10.1007/s00381-018-3959-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 08/19/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We present an overview of the literature on caregiver stress in children with craniosynostosis and report common trends in the literature. INTRODUCTION Craniosynostosis occurs approximately 1 in 2500 births. As this is a diagnosis most common in infants and often requires surgical treatment, this is a significant and stressful ordeal for caregivers. Caregiver stress impacts various outcomes for the child, and little is understood and known about caregiver stress in the pediatric craniosynostosis population. METHODS A literature search for all articles pertaining to craniosynostosis and parental/caregiver stress was conducted using PubMed, Embase, PsychINFO, and CINAHL databases. RESULTS Seven articles on caregiver stress in craniofacial abnormalities patients and three articles on caregiver stress in pediatric craniosynostosis patients specifically were identified. Three articles on parental satisfaction after craniosynostosis repair were also identified and included in the review. Few published studies exist in the literature on caregiver stress in children with craniosynostosis and no clear trends were identified. It is evident that caregiver stress significantly affects the psychosocial outcomes of children with craniosynostosis. However, there are an equal number of studies reporting significant differences in caregiver stress in children with craniosynostosis as those reporting no significant differences. CONCLUSIONS There is evidence that caregiver stress affects psychosocial outcomes of children with craniosynostosis, but no clear trends of either increased or decreased levels of stress were identified in caregivers of children with craniosynostosis. Additional research is needed to identify risk factors related to caregiver stress.
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Mandela R, Bellew M, Chumas P, Nash H. Impact of surgery timing for craniosynostosis on neurodevelopmental outcomes: a systematic review. J Neurosurg Pediatr 2019; 23:442-454. [PMID: 30684935 DOI: 10.3171/2018.10.peds18536] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are currently no guidelines for the optimum age for surgical treatment of craniosynostosis. This systematic review summarizes and assesses evidence on whether there is an optimal age for surgery in terms of neurodevelopmental outcomes. METHODS The databases MEDLINE, PsycINFO, CINAHL, Embase + Embase Classic, and Web of Science were searched between October and November 2016 and searches were repeated in July 2017. According to PICO (participants, intervention, comparison, outcome) criteria, studies were included that focused on: children diagnosed with nonsyndromic craniosynostosis, aged ≤ 5 years at time of surgery; corrective surgery for nonsyndromic craniosynostosis; comparison of age-at-surgery groups; and tests of cognitive and neurodevelopmental postoperative outcomes. Studies that did not compare age-at-surgery groups (e.g., those employing a correlational design alone) were excluded. Data were double-extracted by 2 authors using a modified version of the Cochrane data extraction form. RESULTS Ten studies met the specified criteria; 5 found a beneficial effect of earlier surgery, and 5 did not. No study found a beneficial effect of later surgery. No study collected data on length of anesthetic exposure and only 1 study collected data on sociodemographic factors. CONCLUSIONS It was difficult to draw firm conclusions from the results due to multiple confounding factors. There is some inconclusive evidence that earlier surgery is beneficial for patients with sagittal synostosis. The picture is even more mixed for other subtypes. There is no evidence that later surgery is beneficial. The authors recommend that future research use agreed-upon parameters for: age-at-surgery cut-offs, follow-up times, and outcome measures.
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Kapp-Simon KA, Leroux B, Cunningham M, Speltz ML. Multisite Study of Infants with Single-Suture Craniosynostosis: Preliminary Report of Presurgery Development. Cleft Palate Craniofac J 2017; 42:377-84. [PMID: 16001919 DOI: 10.1597/04-044.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the cognitive and language development of untreated infants with a single suture craniosynostosis at time of diagnosis. Design and Participants The study presents time 1 assessments on the first 100 infants with a single suture craniosynostosis (sagittal, metopic, unilateral coronal, and lambdoid) referred to the Infant Learning Project, a prospective, multisite, longitudinal study evaluating neurocognitive development. Main Outcome Measures Infants were assessed with the mental (Mental Development Index [MDI]) and motor scales (Psychomotor Developmental Index [PDI]) of the Bayley Scales of Infant Development and the Preschool Language Scale receptive (PLS-AC) and expressive (PLS-EC) language scales. Mothers completed the Parenting Stress Inventory, a brief measure of intelligence (maternal IQ [MAT-IQ]), and provided information regarding family socioeconomic status (SES). Results As a group, infants scored significantly lower than the normative data on the MDI (91.9), PDI (83.5), PLS-AC (90.4), and PLS-EC (95.8), and the distribution of scores differed significantly from the expected distribution. MAT-IQ and SES were significantly correlated (.47, p < .01) with mothers of higher IQ coming from higher SES groups. Both MAT-IQ and SES were significantly negatively correlated with life stress events; however, neither MAT-IQ nor SES was correlated with any of the infant development scores. Conclusions There may be a greater developmental risk for infants with a single suture craniosynostosis than previously believed. However, control group data will be necessary to confirm findings.
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Insight into the Pathophysiologic Mechanisms behind Cognitive Dysfunction in Trigonocephaly. Plast Reconstr Surg 2017; 139:954e-964e. [DOI: 10.1097/prs.0000000000003179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marupudi NI, Sood S, Rozzelle A, Ham SD. Effect of molding helmets on intracranial pressure and head shape in nonsurgically treated sagittal craniosynostosis patients. J Neurosurg Pediatr 2016; 18:207-12. [PMID: 27058454 DOI: 10.3171/2016.1.peds15569] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranial vault expansion is performed in pediatric patients with craniosynostosis to improve head shape. Another argument for performing total cranial vault reconstruction is the potential reduction in the harmful effects of elevated intracranial pressure (ICP) that are associated with craniosynostosis. Alternatively, molding helmets have been shown to improve the cranial index (CI) in patients with sagittal synostosis without surgery. However, it is unknown if the use of molding helmets without surgery contributes to adverse changes in ICP. The effect of molding helmets on ICP and CI in patients with sagittal synostosis was investigated. METHODS A prospective cohort study of 24 pediatric patients with sagittal synostosis who planned to undergo total cranial reconstruction was performed from 2011 to 2014 at the Children's Hospital of Michigan. A preoperative molding helmet was used in 13 patients, and no molding helmet was used in 11 patients. End-tidal carbon dioxide, patient positioning, level of sedation, type of anesthetic, and the monitoring site at the time of intraoperative recording were regulated and standardized to establish the accuracy of the ICP readings. CI and head circumference were monitored for each patient. RESULTS The mean duration of the preoperative use of the molding helmet was 17 weeks (range 7-37 weeks). Under controlled settings, the average intraoperative ICP was 7.2 mm Hg (range 2-18 mm Hg) for patients treated with a preoperative molding helmet and 9.5 mm Hg (range 2-22 mm Hg) for patients with no preoperative molding helmet. ICP was not significantly different between the 2 groups, suggesting that the use of a molding helmet in this population is safe. The average CI at the time of helmet placement was 0.70 (range 0.67-0.73), and this improved to an average of 0.74 (range 0.69-0.79) after using the molding helmet for a mean of 17 weeks. CONCLUSIONS ICPs were not significantly different with the use of a preoperative molding helmet, refuting the prevailing thought that molding helmets would be detrimental in children who have craniosynostosis. The use of molding helmet in this population of patients improves head shape and does not adversely affect ICP.
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Affiliation(s)
- Neena I Marupudi
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Sandeep Sood
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Arlene Rozzelle
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Steven D Ham
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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Lee MC, Shim KW, Park EK, Yun IS, Kim DS, Kim YO. Expansion and compression distraction osteogenesis based on volumetric and neurodevelopmental analysis in sagittal craniosynostosis. Childs Nerv Syst 2015; 31:2081-9. [PMID: 26231567 DOI: 10.1007/s00381-015-2843-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Distraction osteogenesis (DO) is a less daunting procedure than extensive cranial vault remodeling and has been used to correct sagittal craniosynostosis. The purposes of this study are to describe DO in combination with expansion and compression procedures and to report analytic results based on the cranial index (CI), volumetric measurement, and neurodevelopmental tests. METHODS Between June 2002 and May 2013, 32 patients with non-syndromic sagittal synostosis who had undergone antero-posterior compression with bitemporal expansion were recruited. Circumferential baseline, mid-sagittal, and bicoronal craniotomies were performed in addition to four-quadrant bone flap procedures via distraction with dural attachment. CI, intracranial volume (ICV), head circumference (HC), and neurodevelopmental outcomes using the Bayley Scales of Infant Development-II (BSID-II) scoring system were analyzed. RESULTS Dolichocephalic CI (68.85 ± 3.61) was altered to mesocephalic CI (78.28 ± 3.74) postoperatively. Preoperative ICV and HC determinations were within the normal range for the majority of participants (normal ICV 87.5%, n = 28; normal HC 75%, n = 24). ICV and HC did not show significant changes with postoperative measurements and were maintained within normal ranges. Regarding neurodevelopment, both the mental and psychomotor developmental indices (MDI, PDI) demonstrated significant improvement (MDI, 88.69 ± 17.38 to 96.23 ± 21.05; PDI, 91.38 ± 16.31 to 100 ± 11.51; p < 0.05). CONCLUSIONS Symmetric sagittal synostosis can be treated comprehensively through DO in combination with expansion and compression procedures. ICV and HC measurements were useful for designing surgical and postoperative distraction strategies. Achievement of mesocephalic CI and neurodevelopmental improvement validated morphological and functional effectiveness.
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Affiliation(s)
- Myung Chul Lee
- Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Kyu Won Shim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Kyung Park
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - In Sik Yun
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Seok Kim
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Oock Kim
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University Health System, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Thwin M, Schultz TJ, Anderson PJ. Morphological, functional and neurological outcomes of craniectomy versus cranial vault remodeling for isolated nonsyndromic synostosis of the sagittal suture: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513090-00021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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Mathijssen IMJ. Guideline for Care of Patients With the Diagnoses of Craniosynostosis: Working Group on Craniosynostosis. J Craniofac Surg 2015; 26:1735-807. [PMID: 26355968 PMCID: PMC4568904 DOI: 10.1097/scs.0000000000002016] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/28/2015] [Indexed: 01/15/2023] Open
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Doshier LJ, Muzaffar AR, Deidrick KK, Rice GB. Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis. Plast Surg (Oakv) 2015; 23:31-4. [PMID: 25821770 DOI: 10.4172/plastic-surgery.1000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Single-suture craniosynostosis (SSC) is a common craniofacial condition with potential neurocognitive sequelae. OBJECTIVE To quantify any long-term functional academic and behavioural difficulties of children with SSC as indicated by the need for individualized education programs (IEPs), despite having undergone surgical treatment. METHODS Records of all school-age patients from 1992 to 2011 who underwent operative intervention for SSC were identified. Fifty-nine patients' guardians were contacted by telephone to provide informed consent for completion of a mailed standardized questionnaire querying demographic information as well as information regarding the patient's health, family and educational history; specifically whether the patient had ever been provided educational support as delineated in an IEP. The primary outcome measure was the history of the patient being assigned educational support as delineated in an IEP. RESULTS Thirty-seven consenting guardians completed and returned the standardized questionnaire (response rate 62.7%). Twenty-one patients were male and 16 were female, with an age range of five to 14 years (mean age 10.2 years). Eleven (29.7%) patients had a previous history of or currently were receiving educational support delineated in an IEP. CONCLUSIONS A higher proportion of school-age patients with a history of SSC (status postsurgical intervention) in the present study received educational support delineated in an IEP than the proportion of IEPs in the general student population of the United States (11.3%).
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Affiliation(s)
- Laura J Doshier
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Arshad R Muzaffar
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | | | - Gale B Rice
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
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Doshier LJ, Muzaffar AR, Deidrick KK, Rice GB. Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Single-suture craniosynostosis (SSC) is a common craniofacial condition with potential neurocognitive sequelae. Objective To quantify any long-term functional academic and behavioural difficulties of children with SSC as indicated by the need for individualized education programs (IEPs), despite having undergone surgical treatment. Methods Records of all school-age patients from 1992 to 2011 who underwent operative intervention for SSC were identified. Fifty-nine patients' guardians were contacted by telephone to provide informed consent for completion of a mailed standardized questionnaire querying demographic information as well as information regarding the patient's health, family and educational history; specifically whether the patient had ever been provided educational support as delineated in an IEP. The primary outcome measure was the history of the patient being assigned educational support as delineated in an IEP. Results Thirty-seven consenting guardians completed and returned the standardized questionnaire (response rate 62.7%). Twenty-one patients were male and 16 were female, with an age range of five to 14 years (mean age 10.2 years). Eleven (29.7%) patients had a previous history of or currently were receiving educational support delineated in an IEP. CONCLUSIONS: A higher proportion of school-age patients with a history of SSC (status postsurgical intervention) in the present study received educational support delineated in an IEP than the proportion of IEPs in the general student population of the United States (11.3%).
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Affiliation(s)
- Laura J Doshier
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Arshad R Muzaffar
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | | | - Gale B Rice
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
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Wall SA, Thomas GPL, Johnson D, Byren JC, Jayamohan J, Magdum SA, McAuley DJ, Richards PG. The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature. J Neurosurg Pediatr 2014; 14:674-81. [PMID: 25259602 DOI: 10.3171/2014.8.peds1425] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. METHODS A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. RESULTS Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. CONCLUSIONS The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.
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Affiliation(s)
- Steven A Wall
- Oxford Craniofacial Unit, Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom
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22
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The Impact of Age at Surgery on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis. Plast Reconstr Surg 2014; 134:608e-617e. [DOI: 10.1097/prs.0000000000000511] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Knight SJ, Anderson VA, Spencer-Smith MM, Da Costa AC. Neurodevelopmental outcomes in infants and children with single-suture craniosynostosis: a systematic review. Dev Neuropsychol 2014; 39:159-86. [PMID: 24742309 DOI: 10.1080/87565641.2014.886690] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Children with single-suture craniosynostosis (SSC) are increasingly considered to be at high risk of adverse neurodevelopmental outcomes. This systematic review aimed to synthesise and critically appraise the existing literature on the neurodevelopmental features of SSC, with particular attention to methodological quality. A total of 33 articles based on 27 cohorts met inclusion criteria. In the context of variable methodological design and quality, most neurodevelopmental studies indicated that children with SSC are at increased risk for difficulties in cognitive, language, and motor domains during infancy (both pre- and post-surgery) and childhood. Limited information exists on factors influencing outcome.
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Affiliation(s)
- Sarah J Knight
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia
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Da Costa AC, Anderson VA, Holmes AD, Lo P, Wray AC, Chong DK, Greensmith AL, Meara JG. Longitudinal study of the neurodevelopmental characteristics of treated and untreated nonsyndromic craniosynostosis in infancy. Childs Nerv Syst 2013; 29:985-95. [PMID: 23358908 DOI: 10.1007/s00381-012-2017-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 12/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Nonsyndromic craniosynostosis (NSC) are a group of congenital disorders sharing premature fusion of one or more of the cranial sutures that restricts and distorts growth of the skull and underlying brain. This study examined the neurodevelopmental sequelae of NSC both prior to and following reconstructive cranial surgery. METHODS Sixty-four consecutive referrals with mixed forms of untreated NSC aged 4 to 16 months (M = 8.9, SD = 2.9) comprised the pre-operative cohort. Forty-four of these patients aged 6 to 32 months (M = 21.2, SD = 4.5) underwent post-operative developmental evaluation. Neurodevelopmental function was assessed with the mental (Mental Development Index) and motor (Psychomotor Development Index) scales of the Bayley Scales of Infant Development-2nd edition. RESULTS Children with untreated NSC displayed significantly lower mental (M = 97.5) and motor (M = 87.7) scores than normative expectations, with the distribution of scores also differing significantly from the normative distribution. Post-operatively, children continued to display significantly lower mental (M = 89.5) and motor (M = 88.0) abilities, with mental abilities falling significantly lower than pre-operative levels. An increased prevalence of severe motor delay was found, and no child displayed accelerated development. Subgroup comparisons revealed no differences in mental or motor skills between the primary diagnostic subtypes (sagittal and metopic synostosis) both prior to and following corrective surgery. CONCLUSIONS NSC is associated with an increased incidence of developmental delay in both treated and untreated conditions. Timing of surgery appears unrelated to developmental outcome.
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Isolated sagittal craniosynostosis: definition, classification, and surgical indications. Childs Nerv Syst 2012; 28:1311-7. [PMID: 22872242 DOI: 10.1007/s00381-012-1834-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 05/29/2012] [Indexed: 01/07/2023]
Abstract
Sagittal craniosynostosis (SC) remains the most common type of synostosis, accounting for about a half of all forms. It would result from a mesenchymal disorder involving the intramembranous ossification of the sagittal suture and leading to its early fusion. No specific data on the etiologic factors are currently available. The premature ossification of the sagittal suture can result in three main types of SC, according to the different segment prevalently involved: anterior, posterior, and complete SC. The diagnosis is easily obtained by clinical examination. However, a radiological work up (3D CT scan) may be necessary to rule out hidden venous or cranial anomalies possibly associated with most severe cases, or for the surgical planning. The most common indication for surgery is the improvement of the cosmetic appearance of the skull, since a cranial deformation may have a significant psychological impact on affected subjects. To relieve from raised intracranial pressure is a further indication to surgery. Although an increased intracranial pressure can be demonstrated in a minority of affected children at diagnosis, indeed, it can present later (usually after the second/third year of life) with chronic symptoms. The role of surgery in the preservation of cognitive functions in scaphocephalic patients does not seem to be relevant, since minor anomalies of the cerebral development associated with SC would occur independently from the cranial shape. On the other hand, the surgical correction may show a protective effect on some visual skills, like the ability to fix and follow, and the fixation shift.
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26
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Da Costa AC, Anderson VA, Savarirayan R, Wrennall JA, Chong DK, Holmes AD, Greensmith AL, Meara JG. Neurodevelopmental functioning of infants with untreated single-suture craniosynostosis during early infancy. Childs Nerv Syst 2012; 28:869-77. [PMID: 22246335 DOI: 10.1007/s00381-011-1660-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Single-suture craniosynostosis (SSC) is a congenital craniofacial disorder, in which premature fusion of one of the skull sutures restricts and distorts growth of the cranium and underlying brain. This disorder of prenatal onset occurs during a critical phase of rapid growth and development of the immature brain. Craniosynostosis carries a known risk of developmental impairment. The neurodevelopmental sequelae of SSC prior to treatment remains however incompletely understood. This study sought to determine the neurodevelopmental sequelae of untreated single-suture craniosynostosis during early infancy. METHODS Fifty-six consecutive patients with unoperated SSC (sagittal, metopic and unicoronal) comprised the sample cohort. Patients were aged between 4 and 16 months (M = 8.9 months, SD = 2.9 months). Neurodevelopmental functioning was assessed with the mental (Mental Development Index) and motor (Psychomotor Development Index) scales of the Bayley Scales of Infant Development, second edition. RESULTS Children with SSC displayed significantly lower mean mental (M = 97.7, SD = 6.7, p < 0.05) and motor (M = 87.7, SD = 13.0, p < 0.001) scores than normative population averages. The distribution of these scores also differed significantly from the normative distribution; an increased rate of significant motor developmental delay was found, and none of the children displayed accelerated development. Subgroup comparisons between the primary diagnostic subtypes in this sample revealed no significant differences in mental or motor skill functioning. CONCLUSIONS Untreated SSC is associated with an increased incidence of developmental delay during early infancy, with motor skills appearing the most vulnerable to impairment during this developmental phase.
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Affiliation(s)
- Annette C Da Costa
- Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital, Melbourne, VIC 3052, Australia.
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27
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Knudsen E, Maltese G, Tarnow P, Tovetjärn R, Kölby L. Parental estimation of early psychological development in children operated on for single suture synostosis. J Plast Surg Hand Surg 2012; 46:152-4. [PMID: 22616804 DOI: 10.3109/2000656x.2012.676555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Impaired psychological development in children with single suture craniosynostosis is often described in the literature. The authors' own experience was that these children appeared to have normal psychological development during their first years of life. The aim of the present study was, therefore, to evaluate if parental estimation would reveal any shortcomings in psychological development. All consecutive patients operated on for non-syndromal single suture synostosis between October 2002 and June 2006 were included (n = 66). A questionnaire was filled out by the parents when the child was 3 years old. The questions concerned development of speech, motor control, personal abilities, and emotional development. The results were compared with randomly selected controls of the same age (n = 180) whose parents answered the same questionnaire. The results showed that children operated on for single suture synostosis did not show any signs of lasting disadvantages due to craniofacial surgery. The children did not in any respect suffer from a hampered psychological development up to 3 years of age. In summary the psychological development of patients operated on for single suture synostosis seems to be normal up to 3 years of age as far as parental estimation can reveal.
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Affiliation(s)
- Elisabet Knudsen
- Institute for Clinical Sciences, Department of Plastic Surgery, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
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28
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Kim SD, Oi S. Immediate spontaneous shape correction using expantile zigzag craniectomy in infantile scaphocephaly -is there an improvement in the developmental quotient following surgery?-. J Korean Neurosurg Soc 2011; 49:194-9. [PMID: 21556244 DOI: 10.3340/jkns.2011.49.3.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 12/29/2010] [Accepted: 02/06/2011] [Indexed: 11/27/2022] Open
Abstract
There is still debate over which method of the surgery is the most appropriate for the treatment of scaphocephalic infants. In addition, change in psychomotor development following these procedures is a very complex issue that has not yet been resolved. In this paper, the authors describe a surgical technique for immediate spontaneous shape correction of infantile scaphocephaly. There were significant differences between pre- and postoperative cephalic index. We also describe an improvement in the developmental quotient following surgery. Therefore, this expantile zigzag craniectomy should be recommended to correct for isolated sagittal craniosynostosis in infants.
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Affiliation(s)
- Sang-Dae Kim
- Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea
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Hankinson TC, Fontana EJ, Anderson RCE, Feldstein NA. Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes. J Neurosurg Pediatr 2010; 6:193-7. [PMID: 20672943 DOI: 10.3171/2010.5.peds09313] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The traditional reasons for surgical intervention in children with single-suture craniosynostosis (SSC) are cosmetic improvement and the avoidance/treatment of intracranial hypertension, which has been thought to contribute to neurocognitive deficits. Despite considerable work on the topic, the exact prevalence of intracranial hypertension in the population of patients with SSC is unknown, although it appears to be present in only a minority. Additionally, recent neuropsychological and anatomical literature suggests that the subtle neurocognitive deficits identified in children with a history of SSC may not result from external compression. They may instead reflect an underlying developmental condition that includes disordered primary CNS development and early suture fusion. This implies that current surgical techniques are unlikely to prevent neurocognitive deficits in patients with SSC. As such, the most common indication for surgical treatment in SSC is cosmetic, and most patients benefit from considerable subjective cosmetic normalization following surgery. Pediatric craniofacial surgeons have not, however, agreed upon objective means to assess postoperative cranial morphological improvement. We should therefore endeavor to agree upon objective craniometric tools for the assessment of operative outcomes, allowing us to accurately compare the various surgical techniques that are currently available.
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Affiliation(s)
- Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital of Alabama, University of Alabama, Birmingham, Alabama, USA.
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Guimarães-Ferreira J, Gewalli F, David L, Olsson R, Friede H, Lauritzen CGK. SPRING-MEDIATED CRANIOPLASTY COMPARED WITH THE MODIFIED PI-PLASTY FOR SAGITTAL SYNOSTOSIS. ACTA ACUST UNITED AC 2009; 37:208-15. [PMID: 14582752 DOI: 10.1080/02844310310001823] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to compare the safety, morphological outcome, and degree of parental satisfaction of the new spring-mediated cranioplasty with those of the modified pi-plasty in the management of sagittal synostosis. Ten patients with non-syndromic sagittal synostosis treated with the spring-mediated cranioplasty were followed prospectively. A control group of 10 sex-matched patients operated on with the modified pi-plasty procedure was chosen. Cephalometric radiographs were obtained preoperatively and postoperatively at 1 year of age. Cephalic index, axial width ratio, length ratio, width ratio and height ratio were used as objective measures of outcome. Parents were sent a questionnaire to obtain a subjective aesthetic assessment of outcome. Significantly less blood replacement was required (p = 0.003), and shorter duration of postoperative anaesthesia (p = 0.030) and postoperative hospital stay (p = 0.013) were found in the spring-mediated cranioplasty group. There were no complications or deaths in either group. Also significant was the inter-group difference in the postoperative change in the height ratio (p = 0.030), the most change being seen in the spring group. The change in the subjective parental aesthetic evaluation of skull shape was significant in both groups. In conclusion, the spring-mediated procedure was morphologically more effective than the modified pi-plasty procedure in the management of sagittal synostosis with the additional benefits of less blood transfusion needed and shorter duration of hospital stay.
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Affiliation(s)
- José Guimarães-Ferreira
- Institute of Human Anatomy, and Department of Plastic Surgery, University of Lisbon School of Medicine, Lisbon, Portugal.
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Maternal reports of satisfaction with care and outcomes for children with craniosynostosis. J Craniofac Surg 2009; 20:138-42. [PMID: 19165011 DOI: 10.1097/scs.0b013e318190e28c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniosynostosis is a congenital deformity caused by premature fusion of cranial suture(s). Surgical outcomes of craniosynostosis have been well documented; however, limited published data are available regarding access to care and social and psychological health outcomes for children with craniosynostosis. The authors conducted a population-based, multistate study of maternal perceptions of care and outcomes for children with craniosynostosis born from January 1998 through December 2003. Mothers of 147 children were contacted and asked to complete a structured telephone interview; 82 mothers (55.8%) participated. Overall, the mean ages of children and their mothers at the time of interview were 4.4 and 34.8 years, respectively. Mothers interviewed tended to be white and, at a minimum, high school graduates. Most mothers reported being satisfied with the craniosynostosis-related information and support provided by medical care providers, and access to primary and specialty care was most often rated as satisfactory. Mothers tended to report the physical health of their child to be good; however, delays in cognitive and emotional development, hearing loss, and speech problems were identified. In addition, statistically significant differences among mothers in each state were noted for reports of the quality of team care, primary care, learning interventions, and perceived need for additional surgeries. These results suggest some limitations in craniosynostosis-related care and provide guidance to medical and surgical care providers in making need-based improvements in craniosynostosis surgery and care. Future studies are recommended to replicate this evaluation in additional populations.
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Starr JR, Kapp-Simon KA, Cloonan YK, Collett BR, Cradock MM, Buono L, Cunningham ML, Speltz ML. Presurgical and postsurgical assessment of the neurodevelopment of infants with single-suture craniosynostosis: comparison with controls. J Neurosurg 2009; 107:103-10. [PMID: 18459881 DOI: 10.3171/ped-07/08/103] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECT Although most infants with single-suture craniosynostosis (SSC) appear to have neurodevelopmental test scores in the average range, SSC has been associated with cognitive and motor delays during infancy. Whether and when surgery improves such deficits are not yet known. The authors aimed to compare the pre- and postsurgical neurodevelopmental status of patients with SSC with those of control infants without craniosynostosis. METHODS The authors conducted a large, multicenter, longitudinal study of 168 infants with craniosynostosis and 115 controls without synostosis who were of similar age, race, sex, and socioeconomic status. The authors assessed participants by using the Bayley Scales of Infant Development, Second Edition (BSID-II) and the Preschool Language Scale, Third Edition (PLS-3) at enrollment, before patients' intracranial surgery, and when participants were 18 months of age (after surgery for patients). RESULTS After adjusting for potential confounding factors in linear regression analyses, the authors found a tendency for patients to perform similarly to or slightly worse than controls on neurodevelopmental examinations at both visits. After surgery, the patients' mean scores were 0.6 to three points lower than those of controls on the five BSID-II and PLS-3 scales (p = 0.02-0.07). Compared with controls, patients had 2.3 and 1.9 times the adjusted odds of scoring in the delayed range on either BSID-II scale (Mental Development Index and Psychomotor Development Index) for the first and second visits, respectively (p = 0.001 and p = 0.015, respectively). The patients' mean adjusted test scores were nearly unrelated to the timing of their surgery. CONCLUSIONS These findings support recommendations for neurodevelopmental screening in infants with SSC. Longer follow-up, as is being conducted with the patients in the present study, will be critical for identifying the potential longer-term correlates of SSC and its surgical correction.
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Affiliation(s)
- Jacqueline R Starr
- Department of Pediatrics, University of Washington, Children's Craniofacial Center, Children's Hospital and Regional Medical Center, Seattle 98105, USA.
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Toth K, Collett B, Kapp-Simon KA, Cloonan YK, Gaither R, Cradock MM, Buono L, Cunningham ML, Dawson G, Starr J, Speltz ML. Memory and response inhibition in young children with single-suture craniosynostosis. Child Neuropsychol 2008; 14:339-52. [PMID: 17899471 PMCID: PMC3470829 DOI: 10.1080/09297040701594888] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Using two versions of the A-not-B task, memory and response inhibition were assessed in 17- to 24-month-old children with surgically corrected single-suture craniosynostosis (cases) and unaffected children (controls). Children's development and language were initially assessed on average at 6-7 months of age and again at this second visit. Cases and controls performed at equivalent levels on average, with cases performing slightly better than controls on several of the variables measured. However, fewer cases than controls were able to complete the more challenging of the two tasks, which may have predictive significance for later functioning. Children's age and cognitive ability were related to successful performance on the A-not-B task. Among cases, age of cranioplastic surgery was unrelated to performance. Our findings suggest that children with single-suture craniosynostosis show normal development of visual memory and response inhibition in the age range studied here.
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Affiliation(s)
- Karen Toth
- Outpatient Child Psychiatry Department, Children’s Hospital & Regional Medical Center, Seattle, WA
| | - Brent Collett
- Outpatient Child Psychiatry Department, Children’s Hospital & Regional Medical Center, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Kathleen A. Kapp-Simon
- Department of Surgery, Northwestern University, Chicago, IL; Craniomaxillofacial Service of Shriners Hospital for Children, Chicago, IL
| | | | - Rebecca Gaither
- Department of Surgery, Northwestern University, Chicago, IL; Craniomaxillofacial Service of Shriners Hospital for Children, Chicago, IL
| | - Mary M. Cradock
- Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Lauren Buono
- Department of Neuropsychology, Children’s Health Care of Atlanta, Atlanta, GA
| | - Michael L. Cunningham
- Department of Pediatrics, University of Washington, Seattle, WA; Children’s Craniofacial Center, Children’s Hospital & Regional Medical Center, Seattle, WA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jacqueline Starr
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA; Children’s Craniofacial Center, Children’s Hospital & Regional Medical Center, Seattle, WA
| | - Matthew L. Speltz
- Outpatient Child Psychiatry Department, Children’s Hospital & Regional Medical Center, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Abstract
Craniosynostosis, premature closures of the skull sutures, results in dysmorphic features if left untreated. Brain growth and cognitive development may also be impacted. Craniosynostosis repair is usually performed in young infants and has its perioperative challenges. This article provides background information about the different forms of craniosynostosis, with an overview of associated anomalies, genetic influences, and their connection with cognitive function. It also discusses the anesthetic considerations for perioperative management, including blood-loss management and strategies to reduce homologous blood transfusions.
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Affiliation(s)
- Jeffrey L Koh
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA.
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Ruiz-Correa S, Starr JR, Lin HJ, Kapp-Simon KA, Cunningham ML, Speltz ML. Severity of skull malformation is unrelated to presurgery neurobehavioral status of infants with sagittal synostosis. Cleft Palate Craniofac J 2007; 44:548-54. [PMID: 17760493 DOI: 10.1597/06-190.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine the association between severity of scaphocephalic skull malformation and neurodevelopmental status prior to cranioplasty. DESIGN AND PARTICIPANTS Seventy-five infants with single-suture sagittal craniosynostosis (median age, 4.5 months) referred to the Infant Learning Project, a prospective, multisite, longitudinal study to evaluate neurocognitive development. MAIN OUTCOME MEASURES Scaphocephaly severity indices were used to quantify synostotic skull shape from computed tomography scans. Infants were assessed with the mental (MDI) and motor scales (PDI) of the Bayley Scales of Infant Development and the receptive (PLS-AC) and expressive (PLS-EC) language scales of the Preschool Language Scale. RESULTS No association between skull shape and neurodevelopmental status was found. CONCLUSIONS Lack of association between skull shape and neurodevelopment in infancy may indicate that the presurgical degree of scaphocephaly has little or no direct effect on brain development. Alternatively, such relationships, if they exist, may be evident only at older ages. Finally, it also is possible that aspects of skull malformation not measured in this study may be related to neuropsychological functioning.
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Affiliation(s)
- Salvador Ruiz-Correa
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC, USA
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Kapp-Simon KA, Speltz ML, Cunningham ML, Patel PK, Tomita T. Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 2007; 23:269-81. [PMID: 17186250 DOI: 10.1007/s00381-006-0251-z] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/21/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Rates of neurocognitive risk range from 35-50% of school-aged children with isolated single suture craniosynostosis (SSC). It has been hypothesized that early surgical intervention to release suture fusion reduces risk for increased intracranial pressure (ICP) and the corresponding risk to neurodevelopment. However, studies assessing children with SSC have been inconsistent in finding an association between neurocognitive development, age of surgery, and ICP. REVIEW SSC produces notable distortion of the cranial vault and underlying brain mass. Although a linear relationship between skull distortion, ICP, and neurocognitive deficits has generally been assumed, recent studies have postulated an interactive process between the skull and developing brain that results in neuroanatomical changes that are not limited to areas directly beneath the fused suture. The specific neuropsychological deficits identified in children with SSC including problems with attention and planning, processing speed, visual spatial skills, language, reading, and spelling may be related to the anatomic differences that persist after correction of suture fusion. CONCLUSIONS Available literature on neurocognitive development of children with SSC is suggestive of mild but persistent neuropsychological deficits, which become more significant as cognitive demands increase at school age. Anatomical studies of children without SSC are beginning to identify particular groups of brain structures that if disrupted or malformed, may be associated with specific cognitive deficits. Controlled research investigating the relationship between persistent anatomical changes and neurocognitive functioning of school-aged children with SSC is needed.
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Affiliation(s)
- Kathleen A Kapp-Simon
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Abstract
Over the past decade there has been a dramatic increase in referrals to specialty clinics, craniofacial centers, plastic surgeons, and neurosurgeons for assessment and treatment of deformational plagiocephaly (DP). Though considered a medically benign condition, preliminary reports suggest that DP may be associated with developmental problems. However, mechanisms to account for this association have not been hypothesized or empirically tested. Although treatment justifications often center on prevention of atypical appearance, little is known about the cosmetic outcomes of treated and untreated children. In this review we hypothesize different etiological pathways linking DP with neurodevelopment (e.g., environmental positioning limitations with and without underlying CNS pathology). We outline directions for research on incidence and prevalence, developmental outcomes, sex differences, determinants of treatment participation, and craniofacial appearance. Despite the paucity of existing research, preliminary findings suggest that children with this condition should be screened and monitored for developmental delays or deficits, as we await more conclusive information from future studies.
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Affiliation(s)
- Brent Collett
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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