Mental Development After Modified ?? Procedure: Dynamic Cranioplasty for Sagittal Synostosis

Abstract

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.

Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis

“…These findings support the conclusions of others that children with SSC manifest cognitive abnormalities long term (2,3,9,10). Follow-up from surgery in the present study was 111.0 months (range 40.9 to 164.8 months), with an average patient age at survey completion of 10.2 years, which is longer than the follow-up of several other studies investigating this topic (2,3,5,6,19). Additionally, unlike other studies, all of the patients in the present study underwent surgical intervention for their SSC (2,10,19,20).…”

“…Because patients usually present in infancy and surgical correction is typically performed by one year of age, most of the research in this area has focused on neurodevelopment in preschool-age children (1)(2)(3)(4)(5)(6). There is a relative paucity of data regarding the performance of these children in later school years.…”

The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

“…This rate is consistent with findings of several studies that examined developmental attainment, learning disability, and speech and language abnormalities in isolated SC. 7,8,13,14,33,44,46 Although, in 1982, Renier et al 41 found that raised ICP was correlated with lower IQ, more recent studies 6,23,34 have failed to confirm the relationship between elevated ICP and neurocognitive outcomes in SC or other single-suture craniosynostosis. The lack of a correlation between developmental delay and raised ICP found in the present study supports the hypothesis that there is no simple causal relationship between ICP and neurocognitive anomalies found in SC.…”

Immediate Spontaneous Shape Correction Using Expantile Zigzag Craniectomy in Infantile Scaphocephaly -Is There an Improvement in the Developmental Quotient Following Surgery?-

“…However, the results of recent studies suggest that the cranial release and reconstruction do not impact mental abilities during infancy 5,10,16,19,24,29,31) . Actually, the test of infant can also be problematic because instruments may not be sensitive to subtle changes in cognitive functions.…”

“…Numerous techniques have been used to correct scaphocephaly in infants including bilateral strip craniectomy, wide-strip craniectomy, the π procedure, total vertex craniectomy, endoscopic craniectomy and cranial vault remodeling with parietal flap cranioplasties 3,4,6,7,10,11,[13][14][15]17,18,20,22,23,[25][26][27][28][29][30] . However, there is still debate over which method of the surgery is most appropriate for the treatment of scaphocephalic infants.…”