Spring-Assisted Strip Craniectomy Versus Cranial Vault Remodeling: Long-Term Psychological, Behavioral, and Executive Function Outcomes

Abstract

Background: Controversy exists regarding the optimal surgical approach for non-syndromic sagittal synostosis. This study provides the first comparative analysis of the long-term behavioral, psychological, and executive function outcomes for patients who underwent either cranial vault remodeling (CVR) or spring-assisted strip craniectomy (SAS). Methods: Thirty-six CVR patients and 39 SAS patients were evaluated. Parents and caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Behavior Assessment System for Children, Second Edition (BASC-2) to evaluate behavioral, emotional, social, adaptive, and executive functioning skills. Results: There were no statistically significant differences between the CVR and the SAS groups (P > 0.05) in any of the BRIEF areas of function. Furthermore, the BASC-2 battery illustrated no significant differences in all areas analyzed except one. Among the 2 groups, the CVR group was rated as having fewer social withdrawal symptoms on the BASC-2 (47.00 ± 10.27) compared to the SAS cohort (54.64 ± 10.96), F = 6.79, P = 0.012, Cohen d = 0.688. However, both means were still within the normal range. Conclusions: Children undergoing SAS and CVR procedures for isolated sagittal synostosis were not rated as having clinically significant behavioral, emotional, social, adaptive, or executive functioning problems on parental forms.

Sagittal Synostosis and Its Association With Cognitive, Behavioral, and Psychological Functioning

“…Among the 25 independent studies (42 articles) 15 , 16 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 38 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 54 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 examining postsurgical results, the largest effect sizes were seen among those that compared test scores of SS groups with those of healthy peers, indicating poorer performances among the former ( Table 4 and eFigure 5 in the Supplement ). However, only studies that involved normative data comparisons reached significance: moderate group differences were noted for visuospatial abilities (6 studies; g w = 0.31; 95% CI, 0.18 to 0.44; P < .001), attention (1 study; g w = −0.51; 95% CI, −0.84 to −0.19; P < .001), and shorter-term memory (2 studies; g w = −0.45; 95% CI, −0.72 to −0.17; P < .001).…”

“…11 More recently, spring-assisted surgery and endoscopic-assisted craniectomies with or without helmets have been JAMA Network Open | Pediatrics described. 1,77 There is a wide disparity of opinions about the appropriate treatment of SS, with extended calvarial vault remodeling being the most commonly performed procedure worldwide. 89 This technique is reproducible and adheres to the principle of removing the affected suture, spanning the adjacent functional suture, and, thus, reducing the primary deformity and allowing space for the brain to grow and expand unhindered.…”

“…The understanding of the SS disease process has evolved, and, with the advent of surgical innovations, the operative approaches for managing patients have changed considerably, from early suturectomy to more extensive cranial vault remodeling and variants thereof . More recently, spring-assisted surgery and endoscopic-assisted craniectomies with or without helmets have been described . There is a wide disparity of opinions about the appropriate treatment of SS, with extended calvarial vault remodeling being the most commonly performed procedure worldwide .…”

Current Controversies in Craniosynostosis Research: A Tribute to Ian Jackson

“…In this study, no statistically significant differences were found between the two groups in terms of behavioral, emotional, social, adaptive, or executive problems. 42 A forthcoming study further investigates the difference between cranial vault remodeling and spring-assisted craniectomy, by analyzing the difference in overall IQ and achievement between patients undergoing the 2 procedures.…”

Sagittal synostosis: does choice of intervention and its timing affect the long-term aesthetic and neurodevelopmental outcome? A single-institution study of 167 children

“…13 However, few studies have assessed the long-term neurodevelopmental impact of specific interventions. One study found no significant difference in behavioral, emotional, or social adaptation between patients undergoing early SAC and those undergoing early CVR, 14 although it is recognized that such results can be affected by the need for reoperation. 15 The aim of this study was to report on both the aesthetic and developmental outcomes of a large cohort of consecutive patients with SC treated in a single craniofacial unit by either SAC or CVR and determine whether differences in outcome could be related to the type or timing of surgery.…”