Long-Term Neurocognitive Outcomes of Spring-Assisted Surgery versus Cranial Vault Remodeling for Sagittal Synostosis

Abstract

Background: A long-term neurocognitive comparison of patients with sagittal synostosis who underwent spring-assisted surgery or cranial vault remodeling has not been performed. Methods: Patients with sagittal synostosis who underwent spring-assisted surgery or cranial vault remodeling were recruited from Wake Forest School of Medicine and Yale School of Medicine, respectively. Cognitive tests administered included an abbreviated intelligence quotient, academic achievement, and visuomotor integration. An analysis of covariance model compared cohorts controlling for demographic variables. Results: Thirty-nine spring-assisted surgery and 36 cranial vault remodeling patients were included in the study. No significant differences between cohorts were found with respect to age at surgery, sex, race, birth weight, family income, or parental education. The cranial vault cohort had significantly older parental age (p < 0.001), and mean age at testing for the spring cohort was significantly higher (p = 0.001). After adjusting for covariates, the cranial vault cohort had significantly higher verbal intelligence quotient (116.5 versus 104.3; p = 0.0024), performance intelligence quotient (109.2 versus 101.5; p = 0.041), and full-scale intelligence quotient (114.3 versus 103.2; p = 0.0032). When included patients were limited to intelligence quotients from 80 to 120, the cranial vault cohort maintained higher verbal (108.0 versus 100.4; p = 0.036), performance (104.5 versus 97.7; p = 0.016), and full-scale (107.6 versus 101.5; p = 0.038) intelligence quotients. The cranial vault cohort had higher visuomotor integration scores than the surgery group (111.1 versus 98.1; p < 0.001). There were no significant differences in academic achievement. Conclusions: Sagittal synostosis patients who underwent cranial vault remodeling had higher intelligence quotient and visuomotor integration scores. There were no differences in academic achievement. Both cohorts had intelligence quotient scores at or above the normal range. Further studies are warranted to identify factors that may contribute to cognitive outcome differences. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Longitudinal Assessment of Neurodevelopment in Patients With Nonsyndromic Single-Suture Craniosynostosis: A Retrospective Review of 66 Patients

“…Although the third edition has been shown to have strong predictive validity compared with prior editions of the Bayley Scales, it is possible that the present study underestimates the severity and/or prevalence of neurodevelopmental delays among patients with NSS craniosynostosis 43. Given the limitations of the Bayley Scales, the craniofacial team at Yale University has utilized the Beery-Buktenica Developmental Test of Visual-Motor Integration, the Wechsler Abbreviated Scale of Intelligence, and the Wechsler Fundamentals to evaluate neurodevelopment 6,8,29. Unfortunately, the use of this neurodevelopmental testing battery has not gained widespread traction among craniofacial teams, perhaps because of the specialized nature and personnel required to administer them.…”

“…43 Given the limitations of the Bayley Scales, the craniofacial team at Yale University has utilized the Beery-Buktenica Developmental Test of Visual-Motor Integration, the Wechsler Abbreviated Scale of Intelligence, and the Wechsler Fundamentals to evaluate neurodevelopment. 6,8,29 Unfortunately, the use of this neurodevelopmental testing battery has not gained widespread traction among craniofacial teams, perhaps because of the specialized nature and personnel required to administer them. It may be well into the future before other craniofacial centers can corroborate the results obtained by the Yale group using this advanced method of testing.…”

“…The morphologic implications of so-called nonsyndromic craniosynostosis are broadly recognized 3–5. However, the neurodevelopmental consequences (cognitive, language, and motor) of this condition are the subject of continued debate in the craniofacial literature 6–8…”

Sagittal Craniosynostosis: Comparing Surgical Techniques using 3D Photogrammetry

“…It causes a higher risk of developing intracranial hypertension (ICH), speech and language problems, intellectual impairment, and psychologic difficulties. [4][5][6][7][8] Background: The aim of this study was to compare three surgical interventions for correction of sagittal synostosis-frontobiparietal remodeling (FBR), extended strip craniotomy (ESC), and spring-assisted correction (SAC)-based on three-dimensional (3D) photogrammetry and operation characteristics. Methods: Patients who were born between 1991 and 2019 and diagnosed with nonsyndromic sagittal synostosis who underwent FBR, ESC, or SAC and had at least one postoperative 3D photogrammetry image taken during one of six follow-up appointments until age 6 were considered for this study.…”

IQ Assessment in Craniofacial Neurocognitive Studies: Interpreting Results Relative to Evidence-based Systematic Analysis

“…Recent studies have evaluated the relationship of timing of surgery, type of surgery, and genetic factors with long-term cognitive function in craniosynostosis. 1 , 2 Intelligence quotient (IQ), which is standardized to a mean score of 100 and standard deviation (SD) of 15, evaluates overall cognitive ability and is a commonly used outcome measure in craniosynostosis research. Concerns have been raised about the generalizability of studies where the reported mean IQ was greater than 100.…”