A prospective developmental assessment was performed on 26 patients operated on with dynamic cranioplasty for sagittal synostosis. Because this technique entails the application of compressive force, it was of great concern to assess the effect of surgery on development and mental status. The surgical technique used was a modified pi procedure. Perioperative variables were recorded. Six patients underwent preoperative intracranial pressure (ICP) measurements. To evaluate objectively the developmental outcome, the Griffiths' Mental Development Scales was used for analysis before and after surgery. A parental questionnaire was used for subjective outcome measurement. Preoperative ICP recordings during sleep ranged from 12.8 to 22.8 mmHg (mean, 16.1 mmHg). The mean age at the time for surgery was 6.9 months (range, 4-16 months; standard deviation [SD], 2.32 months). The surgical technique included shortening of the anteroposterior diameter of the skull by a mean of 16.6 mm. The mean global development quotient (GDQ) preoperatively was 104.5 (range, 82-144; SD, 12.4) and the mean GDQ postoperatively was 101.4 (range, 62-129; SD, 13.6). Mean age at follow-up was 16.3 months (range, 9-40 months; SD, 4.04 months). There was no significant correlation between the amount of intraoperative shortening and mental development. In comparison of means, the GDQ preoperatively did not differ significantly from the GDQ postoperatively. The modified pi procedure is safe and efficient. When surgery was performed before 1 year of age, no significant (p = 0.33) effect on mental development-either detrimental or beneficial-was demonstrated.
Severity of injury is an important factor when assessing outcome, even 10 years after childhood TBI. The TBI group obtained poorer results on most of the measurements compared with healthy controls. Verbal function was strongly affected which needs to be taken into consideration when preparing for rehabilitation programmes. Evaluations of final outcome should not be made before the subjects reach adulthood.
Time since insult is an important factor when assessing outcome after TBI in childhood and adolescence and that assessment of final outcome should not be done before adulthood.
The aim of this study was to investigate health-related quality of life (HRQoL) in a population-based group of young adults with serious traumatic brain injury (TBI) acquired 10 years earlier. In the time period 1987--1991, all 165 residents (<18 years of age) in the south-western health care region of Sweden who had suffered a serious TBI were followed up. Of these, 109 (67%) participated in this follow-up study, which was conducted using the 15-dimension (15D) HRQoL instrument. Their HRQoL was compared with that of 1,039 individuals drawn randomly from the National Population Register for the Finnish Health Care Survey 1995/1996 and matched for age and sex. Nine (mobility, vision, hearing, eating, speech, mental status, depression, distress and usual activities) of the 15 dimensions were significantly aberrant in the TBI group. This TBI group differed markedly from children with organ transplantation, as the transplantation children did not differ from a control group in terms of HRQoL. Compared with other groups of children with congenital or long-lasting conditions, the TBI group had more medical and mental problems.
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