Morphologic Severity of Craniosynostosis: Implications for Speech and Neurodevelopment

Abstract

Background: Single-suture craniosynostosis (SSC) can be associated with neurodevelopmental deficits. We examined the correlation between morphologic severity and incidence of speech-language or psychological concerns. Methods: In 62 patients (33 sagittal, 17 metopic, and 12 unicoronal), morphologic severity was determined via preoperative computed tomography (CT). Severity metrics for sagittal, metopic, and unicoronal synostosis were adjusted cephalic index (aCI), interfrontal angle (IFA), and anterior cranial fossa area ratio (ACFR), respectively. Speech-language and psychological concerns were assessed at age ≥4.5 years and defined as recommendation for therapy or monitoring. Results: Mean assessment age was 5.7 years; 32% had a speech-language concern and 44% had a psychological concern; 44% had neither. Sagittal: Mean aCI of those with a speech-language concern (0.62) and those without (0.62) were equivalent ( P = .580), as were mean aCI of those with a psychological concern (0.62) and those without (0.62; P = .572). Metopic: Mean IFA with (117.9) and without (125.2) a speech-language concern were equivalent ( P = .326), as were mean IFA with (120.2) and without (123.2) a psychological concern ( P = .711). Unicoronal: Mean ACFR with (0.65) and without (0.69) a psychological concern ( P = .423) were equivalent. However, mean ACFR with (0.74) and without (0.63) a speech-language concern were not ( P = .022*). Bivariate rank correlation showed significant association between morphologic severity and speech-language score only for unicoronal synostosis (ρ = .722; P = .008*). Conclusion: A significant portion of patients with SSC had speech-language or psychological concerns. We found no correlation between morphologic severity and incidence of speech-language or psychological concerns for patients with sagittal or metopic synostosis. Morphological severity did correlate with speech concerns in patients with unicoronal synostosis.

Anthropometric Cranial Measurements in Metopic Craniosynostosis/Trigonocephaly: Diagnostic Criteria, Classification of Severity and Indications for Surgery

“…Gabrick et al found out that neurologic symptoms are related to the degree of narrowing of the frontal skull, 34 and some studies 43,44,67,68 demonstrated significant developmental and psychological improvements occur after decompressive cranioplasty. On the other hand, other studies 31,69 found no correlation between the degree of morphologic severity and incidence of speech-language or psychological concerns for patients with metopic synostosis.…”

“…The most frequently used craniometric parameters (Supplementary Digital Content, Table 2, http://links.lww.com/SCS/D285) were: the interfrontal angle (IFA, Fig. 3D, used in 12 studies 11,17,19,21,[25][26][27][28][29][30][31][32] ), the endocranial bifrontal angle (ECA or EBA or EBF, Fig. 3E, used in 9 studies 12,23,24,[33][34][35][36][37][38] ), the interfrontal divergence angle (IFDA, Fig.…”

“…The IFA (Fig. 3D) was the most frequently used angle (it was used in 12 studies, 11,17,19,21,[25][26][27][28][29][30][31][32] Supplementary Digital Content, Table 2, http://links.lww.com/SCS/D285). The IFA was introduced in 2012 by Kellogg et al 11 as the angle formed between the anteriormost point of the cranium and the supraorbital notches.…”

School-age outcomes in patients with unilateral coronal synostosis: comparison of fronto-orbital advancement and endoscopic strip craniectomy

“…[15][16][17][18] Tandon et al found that in patients with unilateral coronal synostosis, preoperative morphological severity is significantly associated with speech-language concerns, but not psychological concerns, at school age. 33 Research has not yet considered whether postoperative severity is also associated with these speech outcomes. Notably, other studies that investigated cognitive and psychosocial outcomes in craniosynostosis 16 used more intensive assessment batteries than the measures used in the present study.…”

Are Patients With Syndromic Craniosynostosis at Greater Risk for Abnormal Speech and Language Development Than Patients With Non-syndromic Craniosynostosis?

“…10 Abnormalities of speech and language have been reported among patients with SCS 11,12 and NSCS. [13][14][15][16][17] These abnormalities include language acquisition delay/disorder, speech production delay/disorder, hypernasality, and velopharyngeal insufficiency. 14,18 Moreover, hearing loss has been noted in both SCS and NSCS, which substantially impairs language acquisition and development.…”