1
|
Osborn AJ, Lange O, Roberts RM. Attention Deficit/Hyperactivity Disorder in Individuals with Non-Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis. Dev Neuropsychol 2024; 49:191-206. [PMID: 38801083 DOI: 10.1080/87565641.2024.2357801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
It is not yet understood whether, and to what extent, craniosynostosis impacts the development of Attention Deficit/Hyperactivity Disorder (ADHD). This PRISMA compliant and PROSPERO pre-registered (ID: CRD42023458640) systematic review and meta-analysis examines the association of single-suture, non-syndromic craniosynostosis with ADHD and inattention/hyperactivity symptoms. Data from 17 independent studies (Nparticipants = 2,389; Mage = 7.3 years) were analyzed, taking into consideration suture location, surgical status, age, and measures administered, where feasible. Few differences were found between cases and controls, but some studies reported high symptom levels. Additional research is required utilizing larger sample sizes and more comprehensive assessment of ADHD.
Collapse
Affiliation(s)
- Amanda J Osborn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Olivia Lange
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Lloyd-White S, Samuel R, Edwards-Bailey L, Piggott K, Blighe S, Bassi A, Hotton M, Horton J, Johnson D, Parks C, Kearney A. The Craniofacial Collaboration UK: Developmental Outcomes in 7- and 10-Year-Old Children With Sagittal Synostosis. J Craniofac Surg 2024:00001665-990000000-01738. [PMID: 38949257 DOI: 10.1097/scs.0000000000010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/20/2024] [Indexed: 07/02/2024] Open
Abstract
The Craniofacial Collaboration UK (CC-UK) protocol is a shared agreement across the 4 UK Highly Specialist Craniofacial Centres (HSCCs) to conduct robust neurodevelopmental and psychosocial clinical screening for children with craniosynostosis. This agreement allows for the analysis of outcomes of a homogenous sample of children with single suture craniosynostosis (SSC), a frequent limitation of the existing research. The current study is the latest analysis of CC-UK data on behavioral, cognitive, and psychosocial outcomes. The focus of this analysis is 7- and 10-year-olds with nonsyndromic sagittal synostosis (SS) who have undergone primary corrective surgery and completed routine clinical screening at 1 of the 4 HSCCs since the introduction of the CC-UK protocol. Due to changes in clinical pathways, only data from 3 HSCCs is included to preserve homogeneity. Results show that the majority of children with SS fall within the average range across behavioral and neurodevelopmental domains. A notable exception was a task involving perceptual reasoning and visuomotor skills (Block Design). Although this difference was small and the mean score remained within the average range, it suggests some increased risk of subtle difficulty with such skills for children with SS. Across other measures, there was no consistent evidence of any significantly increased risk of poorer outcomes, in line with findings of previous CC-UK papers. Understanding the psychological phenotype of SS is a key research priority for parents and clinicians, and the current study is another step toward achieving this goal.
Collapse
Affiliation(s)
- Samuel Lloyd-White
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Rosanna Samuel
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | | | | | - Sabrina Blighe
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Amber Bassi
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Matthew Hotton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jo Horton
- Birmingham Women's and Children's Hospital, UK
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | | | - Anna Kearney
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
3
|
Almeida MN, Alper DP, Barrero C, Parikh N, Hauc SC, Moscarelli J, Golinko M, Persing J, Swanson J, Alperovich M. Radiographic severity is associated with worse executive function in metopic craniosynostosis. Childs Nerv Syst 2024:10.1007/s00381-024-06493-7. [PMID: 38904768 DOI: 10.1007/s00381-024-06493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Children with metopic synostosis have been found to have more neurocognitive and behavioral difficulties. The variables that may affect future neurodevelopmental outcomes, including presenting morphologic severity, have not been fully studied. In the largest study to date, we aimed to assess what portends worse neurocognitive and behavioral outcomes at school age. METHODS Children 6-18 years old with surgically corrected metopic nonsyndromic craniosynostosis underwent neurocognitive testing. Parents completed behavior rating surveys about their child: Conners-3 (ADHD), Social Responsiveness Scale-2 (autism spectrum disorder), Behavior Rating Inventory of Executive Function-2 (BRIEF-2: executive function), and Child's Behavior Checklist (overall behavior). The endocranial bifrontal angle (EBA), adjusted EBA (aEBA), frontal angle (FA), and AI-derived metopic severity score (MSS) were determined on pre-operative CT images. Multivariate linear regressions were used to evaluate the association of age at surgery and severity. RESULTS There were 87 children who underwent neurocognitive testing (average age 10.9 ± 3.3 years) of whom 67 also completed behavioral assessments. Greater phenotypical severity of metopic synostosis (lower FA, aEBA, and EBA) was associated with worse scores on the subscales of the BRIEF-2 (executive function) and executive subscale of the Conners-3. Increasing age at surgery was associated with worse executive function subscale scores of the Conners-3 when controlling for each severity measurement and sociodemographic risk. CONCLUSION Children with greater phenotypic severity of metopic synostosis have worse executive function at school age. The majority of children with metopic synostosis have signs of ADHD. Later surgeries (greater than 12 months) may impact executive functioning, regardless of the degree of severity. Future research should aim at identifying the direct structural changes to the brain.
Collapse
Affiliation(s)
- Mariana N Almeida
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - David P Alper
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Carlos Barrero
- Division of Plastic Surgery, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Neil Parikh
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Sacha C Hauc
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jake Moscarelli
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Michael Golinko
- Division of Plastic Surgery, Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John Persing
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jordan Swanson
- Division of Plastic Surgery, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA.
| |
Collapse
|
4
|
Moscarelli J, Almeida MN, Lacadie C, Hu KG, Ihnat JMH, Parikh N, Persing JA, Alperovich M. A diffusion tensor imaging comparison of white matter development in nonsyndromic craniosynostosis to neurotypical infants. Childs Nerv Syst 2024; 40:1477-1487. [PMID: 38175271 DOI: 10.1007/s00381-023-06262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Nonsyndromic craniosynostosis (NSC) is associated with neurocognitive deficits, and intervention at infancy is standard of care to limit the negative effects of NSC on brain development. In this study, diffusion tensor imaging (DTI) was implemented to investigate white matter microstructure in infants with NSC undergoing cranial vault remodeling, and a comparison was made with white matter development in neurotypical controls. METHODS Infants presenting with NSC (n = 12) underwent DTI scans before and after cranial vault remodeling. Neurotypical infants (n = 5), age matched to NSC patients at preoperative scans, were compared to preoperative DTI scans. Pre- and postoperative NSC scans were compared in aggregate, and the sagittal synostosis (n = 8) patients were evaluated separately. Finally, neurotypical infants from the University of North Carolina/University of New Mexico Baby Connectome Project (BCP), who underwent DTI scans at timepoints matching the NSC pre- and postoperative DTI scans, were analyzed (n = 9). Trends over the same time period were compared between NSC and BCP scans. RESULTS No significant differences were found between preoperative NSC scans and controls. White matter development was more limited in NSC patients than in BCP patients, with microstructural parameters of the corpus body and genu and inferior and superior longitudinal fasciculi consistently lagging behind developmental changes observed in healthy patients. CONCLUSION Infant white matter development appears more limited in NSC patients undergoing cranial vault remodeling relative to that in neurotypical controls. Further investigation is needed to explore these differences and the specific effects of early surgical intervention.
Collapse
Affiliation(s)
- Jake Moscarelli
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Mariana N Almeida
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Cheryl Lacadie
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin G Hu
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jacqueline M H Ihnat
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Neil Parikh
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - John A Persing
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA.
| |
Collapse
|
5
|
Chiang SN, Fotouhi AR, Doering MM, Skolnick GB, Naidoo SD, Strahle JM, McEvoy SD, Patel KB. Cognitive Development in Lambdoid Craniosynostosis: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2024; 61:450-457. [PMID: 36177519 DOI: 10.1177/10556656221129978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Lambdoid craniosynostosis affects approximately 1 in 33 000 live births per year, and surgical correction is often sought in order to achieve normocephaly and allow for adequate brain growth. However, the effects of lambdoid synostosis and its treatment on cognitive development are unknown. DESIGN Systematic review and meta-analysis. PATIENTS, PARTICIPANTS A systematic review of Ovid Medline, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov was conducted in January 2022. Included studies assessed cognitive development of patients with nonsyndromic unilateral lambdoid craniosynostosis. MAIN OUTCOME MEASURES Results of developmental tests were compared to normative data or controls to generate Hedges' g for meta-analysis. RESULTS Nine studies met the inclusion criteria. Meta-analysis of 3 studies describing general cognition showed that cases scored significantly lower than their peers, but within 1 standard deviation (g = 0.37, 95% CI [-0.64, -0.10], P = .01). Meta-analysis of verbal and psychomotor development showed no significant differences in children with lambdoid synostosis. Studies were of fair quality and had moderate-to-high heterogeneity. CONCLUSIONS Patients with lambdoid craniosynostosis may score slightly below average on tests of general cognition in comparison to normal controls, but results in other domains are variable. Analyses were limited by small sample sizes. Multidisciplinary care and involvement of a child psychologist may be helpful in identifying areas of concern and providing adequate scholastic support. Further research recruiting larger cohorts will be necessary to confirm these findings and extend them to other developmental domains such as attention and executive function.
Collapse
Affiliation(s)
- Sarah N Chiang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Annahita R Fotouhi
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Michelle M Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Gary B Skolnick
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sybill D Naidoo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sean D McEvoy
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Kamlesh B Patel
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
6
|
Liang QC, Chen X, Yang B, Song YH, Sun SQ, Jing JJ, De Vito A, Hall WA, Ganau M, Bao N. Bilateral fronto-orbital advancement combined with cranial vault release using a free-floating bone flap technique for nonsyndromic unilateral coronal synostosis. Transl Pediatr 2023; 12:2213-2221. [PMID: 38197103 PMCID: PMC10772842 DOI: 10.21037/tp-23-495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024] Open
Abstract
Background The goals of operative treatment for unilateral coronal synostosis (UCS) are to improve appearance and allow unrestricted brain growth. However, for severe unilateral premature closure of the coronal suture, existing methods do not address the compression of the brain or expand the volume of the skull cavity. We report our retrospective experience with bilateral fronto-orbital advancement combined with cranial vault release using a free-floating bone flap (CVR + FFBF) technique and the resulting changes in the anterior cranial vault asymmetry index (ACVAI) and intracranial volume. Methods Twenty patients with UCS who underwent bilateral fronto-orbital advancement combined with CVR + FFBF technique from April 2014 to May 2019 were included. Surgical efficacy was evaluated by the ACVAI and intracranial volume before the operation, 1 week after the operation, and at the last follow-up (average 19.8 months; range, 12 to 40 months). The measurement data are presented as the mean ± standard deviation and were statistically analyzed by t-test. Results The ACVAI was 9.07%±3.55% before the operation, 3.56%±3.42% 1 week after the operation, and 3.13%±2.41% at the last follow-up. The ACVAI 1 week after the operation was significantly lower than that before the operation (t=4.827, P<0.001). There was no significant difference between the ACVAI 1 week after the operation and at the last follow-up (t=0.660, P=0.517). The intracranial volume was 1,027.85±112.25 mL in patients before the operation and 1,131.92±161.71 mL in the normal control group, which was a statistically significant difference (t=2.364, P=0.023). The intracranial volume significantly increased 1 week after surgery: 1,081.62±111.10 mL (t=8.703, P<0.001), and this trend continued at the last follow-up (1,386.90±119.30 mL) similarly to the normal control group (1,438.22±89.28 mL). At the last follow-up, there was no significant difference between the two groups (t=1.540, P=0.132). Conclusions For the treatment of UCS, bilateral fronto-orbital advancement combined with CVR + FFBF technique offers functional and cosmetic outcomes in terms of intracranial volume expansion and fronto-orbital symmetry.
Collapse
Affiliation(s)
- Qin-Chuan Liang
- Department of Neurosurgery, Shanghai Children’s Medical Center Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Xi Chen
- Department of Neurosurgery, Shanghai Children’s Medical Center Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Bo Yang
- Department of Neurosurgery, Shanghai Children’s Medical Center Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Yun-Hai Song
- Department of Neurosurgery, Shanghai Children’s Medical Center Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Shou-Qing Sun
- Department of Neurosurgery, Shanghai Children’s Medical Center Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Jun-Jie Jing
- Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China
| | - Andrea De Vito
- Department of Neuroradiology, H. S. Gerardo Monza, Monza, Italy
| | - Walter A. Hall
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nan Bao
- Department of Neurosurgery, Shanghai Children’s Medical Center Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
7
|
Ho ES, Hong B, Steen K, Stephens D, Phillips JH, Forrest CR. Academic Achievement in School-Aged Children with Single Suture Craniosynostosis Over Time. Plast Surg (Oakv) 2023; 31:287-292. [PMID: 37654538 PMCID: PMC10467443 DOI: 10.1177/22925503211048526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 09/02/2023] Open
Abstract
Introduction: Children with single suture craniosynostosis (SSC) are at risk for neurocognitive problems. The reported magnitude of differences between children with SSC and their normative peers on standardized tests of academic and intellectual ability are small. Evaluation of real-world academic outcomes of these children and its impact on educational resources have not been conducted. Methods: A retrospective cohort study of academic outcomes of children with SSC was conducted using the data from Ontario's Education Quality and Accountability Office (EQAO) standardized provincial reading, writing and mathematics tests. The need for special education was identified by documentation of the child's need for an Identification, Placement, and Review Committee (IPRC). Results: Of 296 eligible children, 42 participated in the study. Half of the children had sagittal synostosis, while the remaining were 10 (24%) unicoronal, 9 (21%) metopic, and 2 (5%) lambdoid synostosis. Thirty-six (86%) underwent operative management. The EQAO scores of operated children with SSC met the provincial academic standards on the Grade 3 and 6 EQAO scores across the 3 academic subjects. Converted grade-matched EQAO scores decreased in reading and writing over time, while math improved. Of the 21 patients with special education data, one child required an IPRC in Grade 3, while an additional four (24%) required an IPRC in Grade 6. Conclusions: Operated children with SSC had average academic performance, however, their needs appeared to change over time. Future studies are needed to evaluate academic difficulties and special education needs as these children progress through grade school.
Collapse
Affiliation(s)
- Emily S. Ho
- University of Toronto, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
8
|
Junn AH, Long AS, Hauc SC, Almeida MN, Alper DP, Rivera JC, Mayes L, Persing JA, Alperovich M. Long-term neurocognitive outcomes in 204 single-suture craniosynostosis patients. Childs Nerv Syst 2023; 39:1921-1928. [PMID: 36877207 DOI: 10.1007/s00381-023-05908-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Craniosynostosis, which describes premature fusion of one or more cranial sutures, has been associated with a variety of neurocognitive deficits. We sought to explore the cognitive profiles of the various types of single-suture, non-syndromic craniosynostosis (NSC). METHODS A retrospective review of children 6-18 years old with surgically corrected NSC who underwent neurocognitive testing (Weschler Abbreviated Scale of Intelligence, Beery-Buktenica Developmental Test of Visuomotor Integration) from the years 2014-2022 was conducted. RESULTS 204 patients completed neurocognitive testing (139 sagittal, 39 metopic, 22 unicoronal, 4 lambdoid suture). 110 (54%) of the cohort was male, and 150 (74%) were White. Mean IQ was 106.10±14.01 and mean age at surgery and testing were 9.0±12.2 months and 10.9±4.0 years, respectively. Sagittal synostosis was associated with higher scores than metopic synostosis, with significant differences in verbal IQ (109.42±15.76 vs 101.37±10.41), full-scale IQ (108.32±14.44 vs 100.05±11.76), visuomotor integration (101.62±13.64 vs 92.44±12.07), visual perception (103.81±12.42 vs 95.87±11.23), and motor coordination (90.45±15.60 vs 84.21±15.44). Sagittal synostosis was associated with significantly higher scores for visuomotor integration (101.62±13.64 vs 94.95±10.24) and visual perception (103.81±12.42 vs 94.82±12.75) than unicoronal synostosis. CONCLUSIONS Compared to patients with sagittal synostosis, patients with metopic synostosis exhibited lower scores in verbal IQ, full-scale IQ, visuomotor integration, visual perception, and motor control after surgical correction. Despite surgical correction for premature metopic suture fusion, the effect on the adjacent frontal lobe and white matter connections to other regions of the brain may have a lasting functional impact. Patients with unicoronal synostosis exhibited lower visuomotor integration and visual perception scores.
Collapse
Affiliation(s)
- Adam H Junn
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Aaron S Long
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Sacha C Hauc
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Mariana N Almeida
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - David P Alper
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jean Carlo Rivera
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Linda Mayes
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - John A Persing
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Michael Alperovich
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA.
| |
Collapse
|
9
|
Kljajić M, Maltese G, Tarnow P, Sand P, Kölby L. Health-related quality of life of children treated for non-syndromic craniosynostosis. J Plast Surg Hand Surg 2023; 57:408-414. [PMID: 36409664 DOI: 10.1080/2000656x.2022.2147532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health-related quality of life (HRQoL) allows the acquisition of the subjective perspective of patients regarding their health and function; yet a very few studies have been evaluated HRQoL of patients treated for craniosynostosis (CS). In this retrospective, descriptive cohort study, school-aged children (7-16 years) treated for non-syndromic CS were assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales. Seventy-three patients and their parents responded to the PedsQL (response rate: 80.2%). Patients generally estimated average HRQoL with no difference compared to the normal population sample. Further, no difference in HRQoL was found between treated sagittal (SS) or metopic synostosis. In the SS group, surgical methods involving spring-assisted surgery and pi-plasty were unrelated to HRQoL outcomes. Additionally, HRQoL was highly correlated with intelligence quotient (IQ, r = 0.42; p = 0.0004) and adaptive behavior skills (ABAS, r = 0.57; p = 0.0001). Furthermore, differences were observed in estimated physical function (p = 0.002) and school function (p = 0.012) between self- and proxy reports (i.e. parents estimated child HRQoL as higher than did the children). Children treated for CS have a generally average HRQoL, and neither CS type nor surgical method influenced HRQoL outcomes. Moreover, children and parents estimated HRQoL differently, suggesting the importance of using both self- and proxy reporting in patient-reported measures. HRQoL was strongly related to IQ and ABAS, indicating that the PedsQL can be used as a screening instrument to identify craniofacial patients in need of further psychological assessment.
Collapse
Affiliation(s)
- Marizela Kljajić
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giovanni Maltese
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Sand
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
10
|
Fotouhi AR, Chiang SN, Peterson AM, Doering MM, Skolnick GB, Naidoo SD, Strahle JM, McEvoy SD, Patel KB. Neurodevelopment in unilateral coronal craniosynostosis: a systematic review and meta-analysis. J Neurosurg Pediatr 2023; 31:16-23. [PMID: 36272117 DOI: 10.3171/2022.9.peds22283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current literature on unilateral coronal craniosynostosis is replete with repair techniques and surgical outcomes; however, information regarding neurodevelopment remains unclear. Therefore, the aim of this systematic review and meta-analysis was to comprehensively assess the neurodevelopmental outcomes of patients with unicoronal craniosynostosis compared with their healthy peers or normative data. METHODS A systematic review of the Ovid MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov databases from database inception to January 19, 2022, was performed. Included studies assessed neurodevelopment of patients with unicoronal craniosynostosis. Two independent reviewers selected studies and extracted data based on a priori inclusion and exclusion criteria. Results of developmental tests were compared with normative data or controls to generate Hedges' g statistics for meta-analysis. The quality of included studies was evaluated using the National Institutes of Health Assessment Tool. RESULTS A total of 19 studies were included and analyzed, with an overall fair reporting quality. A meta-analysis of 325 postoperative patients demonstrated that scores of general neurodevelopment were below average but within one standard deviation of the norm (Hedges' g = -0.68 [95% CI -0.90 to -0.45], p < 0.001). Similarly, postoperative patients exhibited lower scores in verbal, psychomotor, and mathematic outcome assessments. CONCLUSIONS This systematic review and meta-analysis found that patients with unicoronal craniosynostosis had poorer neurodevelopment, although scores generally remained within the normal range. These data may guide implementation of regular neurocognitive assessments and early learning support of patients with unicoronal craniosynostosis.
Collapse
Affiliation(s)
- Annahita R Fotouhi
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah N Chiang
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew M Peterson
- 2Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michelle M Doering
- 3Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri; and
| | - Gary B Skolnick
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sybill D Naidoo
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer M Strahle
- 4Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sean D McEvoy
- 4Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kamlesh B Patel
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
11
|
Assessing Long-Term Neurodevelopment among Children with Non-Syndromic Single Suture Craniosynostosis. World J Plast Surg 2022; 11:57-61. [PMID: 36117890 PMCID: PMC9446125 DOI: 10.52547/wjps.11.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Single suture craniosynostosis (SSC) is a disorder, affecting brain growth. Reviewing literature reveals controversialists of papers in this field. Methods: This prospective study was conducted from 2014 to 2016. All the individuals, aged 2 to 16 years, whose medical records files were complete, with SSC from 1999 to 2013 were included. All patients had undergone cranial vault remodeling at Mofid Hospital, Tehran, Iran. Wechsler questionnaires, WPPSI-III and WISC-IV, were completed for each child based on his/her age. Results: Seventy children were included, with the mean age of 6.7 (±2.9) years. Forty-six (65.7%) children were boys while 24 (34.3%) were girls. Mean FSIQ for all of children was 95.5 (±13.2). Mean verbal IQ, performance IQ, verbal comprehension, perceptual reasoning, processing speed, and working memory are 93.4 (±14.1), 96.1 (±13.3), 97.5 (±13.9), 102.2 (±12.5), 94.5 (±9.8), and 97.5 (±12.9), respectively. There was statistically significant difference between FSIQ of children with SSC and that of unaffected children (P-value<0.05). There was significant difference between verbal IQ of children with SSC and that of unaffected ones (P-value< 0.007). There was significant difference between in processing speed between affected children and unaffected children (P-value<0.012). Conclusion: Children, aged 2 to 6 years, with SSC had a significantly lower Verbal IQ, and children, aged 6 to 16 years, with SSC had a significantly lower processing speed than their healthy counterparts. Though FSIQ of children with SSC falls within normal range, it is a little lower than healthy peers.
Collapse
|
12
|
Kalmar CL, Lang SS, Heuer GG, Schreiber JE, Tucker AM, Swanson JW, Beslow LA. Neurocognitive outcomes of children with non-syndromic single-suture craniosynostosis. Childs Nerv Syst 2022; 38:893-901. [PMID: 35192026 DOI: 10.1007/s00381-022-05448-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/06/2022] [Indexed: 01/17/2023]
Abstract
While the focus of craniosynostosis surgery is to improve head shape, neurocognitive sequelae are common and are incompletely understood. Neurodevelopmental problems that children with craniosynostosis face include cognitive and language impairments, motor delays or deficits, learning disabilities, executive dysfunction, and behavioral problems. Studies have shown that children with multiple suture craniosynostosis have more impairment than children with single-suture craniosynostosis. Children with isolated single-suture subtypes of craniosynostosis such as sagittal, metopic, and unicoronal craniosynostosis can have distinct neurocognitive profiles. In this review, we discuss the unique neurodevelopmental profiles of children with single-suture subtypes of craniosynostosis.
Collapse
Affiliation(s)
- Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, Philadelphia, USA
| | - Shih-Shan Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, PA, Philadelphia, USA.,Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, PA, Philadelphia, USA
| | - Gregory G Heuer
- Division of Neurosurgery, Children's Hospital of Philadelphia, PA, Philadelphia, USA.,Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, PA, Philadelphia, USA
| | - Jane E Schreiber
- Department of Child & Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, PA, Philadelphia, USA.,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, PA, Philadelphia, USA
| | - Alexander M Tucker
- Division of Neurosurgery, Children's Hospital of Philadelphia, PA, Philadelphia, USA
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, PA, Philadelphia, USA.,Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, PA, Philadelphia, USA
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, PA, Philadelphia, USA. .,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, PA, Philadelphia, USA. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, PA, Philadelphia, USA.
| |
Collapse
|
13
|
Using Patient-Reported Outcome Measures to Screen for Cognitive Function Deficits and Stigma in Patients with Single-Suture Craniosynostosis. Plast Reconstr Surg 2022; 149:743e-748e. [PMID: 35171893 DOI: 10.1097/prs.0000000000008939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
SUMMARY Children with single-suture craniosynostosis have small but significant deficits in appearance ratings and neurodevelopment. Traditionally, these parameters are studied using a full battery of examinations, which are very time consuming. This study evaluated a convenient method to measure psychosocial parameters in this population by utilizing patient-reported outcomes measures to evaluate cognitive function and stigma. Stigma and cognitive function were measured, using the Patient-Reported Outcomes Measurement Information System and Quality of Life in Neurological Disorders questionnaires, in 59 consecutive patients at least 5 years old presenting to clinic from July of 2018 to January of 2020 with repaired single-suture craniosynostosis. Parents completed parent proxy cognitive function surveys for patients under age 8. Questionnaires were administered electronically as part of clinical care. Scores were automatically transferred to the electronic medical record and correlated with previously acquired Child Behavior Checklist results. Median time to complete the questionnaires was 57 and 49 seconds, respectively. Stigma and cognitive function were significantly correlated with the associated Child Behavior Checklist subscores (Spearman's rho, -0.384, p = 0.023; and Spearman's rho, -0.683, p = 0.001, respectively). The Patient-Reported Outcomes Measurement Information System and Quality of Life in Neurological Disorders questionnaires offer a convenient method of screening psychosocial parameters in children with single-suture craniosynostosis that otherwise would be difficult to obtain during standard visits. Short completion times and electronic scoring increase clinical utility. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
Collapse
|
14
|
Reardon T, Fiani B, Kosarchuk J, Parisi A, Shlobin NA. Management of Lambdoid Craniosynostosis: A Comprehensive and Systematic Review. Pediatr Neurosurg 2022; 57:1-16. [PMID: 34864743 DOI: 10.1159/000519175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Craniosynostosis is a condition characterized by the premature fusion of 2 or more skull bones. Craniosynostosis of the lambdoid suture is one of the rarest forms, accounting for 1-4% of all craniosynostoses. Documented cases are separated into simple (single suture), complex (bilateral), and associated with adjacent synostoses ("Mercedes Benz" Pattern) or syndromes (i.e., Crouzon, Sathre-Chotzen, Antley-Bixler). This condition can manifest phenotypic deformities and neurological sequelae that can lead to impaired cognitive function if improperly treated or left undiagnosed. Preferred surgical techniques have varied over time but all maintain the common goals of establishing proper head shape and preventing of complications that could contribute to aforementioned sequelae. SUMMARY This comprehensive review highlights demographic distributions, embryological development, pathogenesis, clinical presentation, neurological sequelae, radiologic findings, surgical techniques, surgical outcomes, and postoperative considerations of patients with lambdoid craniosynostosis presentation. In addition, a systematic review was conducted to explore the operative management of lambdoid craniosynostosis using PubMed, Embase, and Scopus databases, with 38 articles included after screening. Key Messages: Due to a low volume of published cases, diagnosis and treatment can vary. Large overlap in presentation can occur in patients that display lambdoid craniosynostosis and posterior plagiocephaly, furthering the need for comprehensive analysis. Possessing the knowledge and tools to properly assess patients with lambdoid craniosynostosis will allow for more precise care and improved outcomes.
Collapse
Affiliation(s)
- Taylor Reardon
- Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | - Brian Fiani
- Desert Regional Medical Center, Palm Springs, California, USA
| | | | | | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
15
|
Kalmar CL, Zapatero ZD, Kosyk MS, Carlson AR, Bartlett SP, Heuer GG, Tucker AM, Taylor JA, Lang SS, Swanson JW. Elevated intracranial pressure with craniosynostosis: a multivariate model of age, syndromic status, and number of involved cranial sutures. J Neurosurg Pediatr 2021; 28:716-723. [PMID: 34560658 DOI: 10.3171/2021.6.peds21162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with multiple prematurely fused cranial sutures and those undergoing surgical correction later in life appear to experience worse neurocognitive outcomes, but it is unclear whether higher intracranial pressure (ICP) is implicated in this process. The purpose of this study was to elucidate the effect of age at intervention and number of involved cranial sutures on ICP, as well as to assess which cranial suture closure may be more associated with elevated ICP. METHODS The prospective craniofacial database at the authors' institution was queried for patients undergoing initial corrective surgery for craniosynostosis in whom intraoperative measurement of ICP was obtained prior to craniectomy. Age, involved sutures, and syndromic status were analyzed in the context of measured ICP by using multiple linear regression. RESULTS Fifty patients met the inclusion criteria. Age at procedure (p = 0.028, β = +0.060 mm Hg/month) and multiple-suture involvement (p = 0.010, β = +4.175 mm Hg if multisuture) were both significantly implicated in elevated ICP. The actual number of major sutures involved was significantly correlated to ICP (p = 0.001; β = +1.687 mm Hg/suture). Among patients with single-suture involvement, there was an overall significant difference of median ICP across the suture types (p = 0.008), with metopic having the lowest (12.5 mm Hg) and sagittal having the highest (16.0 mm Hg). Patients with multiple-suture involvement had significantly higher ICP (p = 0.003; 18.5 mm Hg). Patients with craniofacial syndromes were 79.3 times more likely to have multiple-suture involvement (p < 0.001). Corrective surgery for craniosynostosis demonstrated significant intraoperative reduction of elevated ICP (all p < 0.050). CONCLUSIONS Syndromic status, older age at intervention for craniosynostosis, and multiple premature fusion of cranial sutures were associated with significantly higher ICP.
Collapse
Affiliation(s)
- Christopher L Kalmar
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Zachary D Zapatero
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Mychajlo S Kosyk
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Anna R Carlson
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Scott P Bartlett
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Gregory G Heuer
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Alexander M Tucker
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jesse A Taylor
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Shih-Shan Lang
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jordan W Swanson
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| |
Collapse
|
16
|
Akai T, Yamashita M, Shiro T, Hamada S, Maruyama K, Iizuka H, Kuroda S. Long-term Outcomes of Non-syndromic and Syndromic Craniosynostosis: Analysis of Demographic, Morphologic, and Surgical Factors. Neurol Med Chir (Tokyo) 2021; 62:57-64. [PMID: 34707067 PMCID: PMC8841231 DOI: 10.2176/nmc.oa.2021-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In this study, we analyzed the outcomes of patients (followed for 5–38 years, average 17.3 years) with craniosynostosis and evaluated their long-term prognosis. In all, 51 patients who underwent surgery for craniosynostosis between 1982 and 2015, including 12 syndromic and 39 non-syndromic cases, were included. The average age at the initial surgery was significantly lower in the syndromic group than that in the non-syndromic group (9.8 months old vs. 19.9 months, respectively). The surgical procedures did not significantly differ between the two groups, but repeat surgery was significantly more common in the syndromic group than in the non-syndromic group (4 children [30.8%] and 3 children [7.7%], respectively). The children requiring repeat surgery tended to be younger at the initial surgery than those who did not. Those patients who required repeat surgery did not have significantly different surgical procedures initially. The incidence of developmental retardation was 49.0% (43.5% in the non-syndromic group and 66.7% in the syndromic group), and only two children in the non-syndromic group displayed recovery. This study is the first to analyze the prognosis for patients who were followed for at least 5 years after cranioplasty. Repeat surgery was common, especially in syndromic patients. Severity of skull deformity and early initial surgery may be important factors determining the need for repeat surgery. Developmental retardation was also common, and improvement was rare even after surgery.
Collapse
Affiliation(s)
- Takuya Akai
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama
| | - Masanobu Yamashita
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kanazawa Medical University
| | - Taisuke Shiro
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama
| | - Saori Hamada
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama
| | - Kunitaka Maruyama
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama
| | - Hideaki Iizuka
- Department of Neurosurgery, Faculty of Medicine, Kanazawa Medical University
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama
| |
Collapse
|
17
|
Osborn AJ, Roberts RM, Dorstyn DS, Grave BG, David DJ. Sagittal Synostosis and Its Association With Cognitive, Behavioral, and Psychological Functioning: A Meta-analysis. JAMA Netw Open 2021; 4:e2121937. [PMID: 34515785 PMCID: PMC8438597 DOI: 10.1001/jamanetworkopen.2021.21937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Findings on the cognitive, behavioral, and psychological functioning of individuals with sagittal synostosis (SS) are highly disparate, limiting their clinical utility. OBJECTIVE To identify and review research on individuals with SS and to determine whether, and to what extent, they experience cognitive, behavioral, and psychological difficulties compared with their healthy peers or normative data for each measure. DATA SOURCES PubMed, Scopus, Embase, and PsycINFO were searched through January 2021 with no date restrictions. Scopus citation searches and manual checks of the reference lists of included studies were conducted. STUDY SELECTION Studies included participants of any age who had received a diagnosis of single-suture (isolated or nonsyndromic) SS or scaphocephaly and who had been assessed on cognitive, behavioral, and psychological outcomes. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 reviewers. Case-control outcomes (individuals with SS vs healthy peers or normative data) were compared using random-effects models with 3 effect sizes calculated: weighted Hedges g (gw), odds ratios (ORs), and mean prevalence rates. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. MAIN OUTCOMES AND MEASURES Findings were categorized by surgical status (conservatively managed, presurgery, postsurgery, or combined); domain (eg, general cognition); type of cognitive, behavioral, or psychological measure (objective or subjective); and source of comparison data (peers or normative data). RESULTS Data from 32 studies, involving a pooled sample of 1422 children and adults with SS (mean [SD] age at assessment, 5.7 [6.6] years; median [interquartile range] age, 3.3 [0.5-10.3] years), were analyzed. Data on sex were available for 824 participants, and 642 (78%) were male. Individual study results varied substantially. Objective tests identified significant moderate group differences on 3 of 16 examined domains: presurgical motor functioning (3 studies; gw = -0.42; 95% CI, -0.67 to -0.18; P < .001), postsurgical short-term memory (2 studies; gw = -0.45; 95% CI, -0.72 to -0.17; P < .001), and postsurgical visuospatial ability (6 studies; gw = 0.31; 95% CI, 0.18 to 0.44; P < .001). Prevalence estimates and ORs varied widely, with 15 studies showing prevalence estimates ranging from 3% to 37%, and 3 studies showing ORs ranging from 0.31 (95% CI, 0.01 to 6.12) for processing speed in the conservatively managed sample to 4.55 (95% CI, 0.21 to 98.63) for postsurgical visuospatial abilities. CONCLUSIONS AND RELEVANCE In this meta-analysis, findings for the functioning of participants with SS were highly disparate and often of low quality, with small samples sizes and control groups rarely recruited. Nonetheless, the findings suggest that some individuals with SS experience negative outcomes, necessitating routine assessment.
Collapse
Affiliation(s)
- Amanda J. Osborn
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M. Roberts
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Diana S. Dorstyn
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ben G. Grave
- Craniofacial Australia, North Adelaide, South Australia, Australia
| | - David J. David
- Craniofacial Australia, North Adelaide, South Australia, Australia
| |
Collapse
|
18
|
Long-Term Neurocognitive Outcomes of Spring-Assisted Surgery versus Cranial Vault Remodeling for Sagittal Synostosis. Plast Reconstr Surg 2021; 147:661-671. [PMID: 33620934 DOI: 10.1097/prs.0000000000007640] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
Collapse
|
19
|
Children Treated for Nonsyndromic Craniosynostosis Exhibit Average Adaptive Behavior Skills with Only Minor Shortcomings. Plast Reconstr Surg 2021; 147:453-464. [PMID: 33565829 DOI: 10.1097/prs.0000000000007541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adaptive behavior skills are important when assessing cognitive functions related to daily life; however, few studies have assessed these skills in patients treated for nonsyndromic craniosynostosis. In this study, the authors assessed the adaptive behavior skills of children treated for craniosynostosis and examined whether their outcomes are related to surgical technique. METHODS The Adaptive Behavior Assessment System, 2nd Edition, parent report was used for children (age, 7 to 16 years) treated for sagittal (n = 41), metopic (n = 24), and other rare synostoses (n = 8). Background data, including intelligence quotient, were controlled for confounders. RESULTS All evaluated children treated for craniosynostosis were estimated as lower in all aspects of adaptive behavior skills (full-scale, conceptual, social, and practical composites; effect size, 0.36 to 0.44) as compared with norms. The sagittal group showed shortcomings in social composite (effect size, 0.48) and subscales measuring self-care and self-direction, although no difference was observed between spring-assisted surgery and pi-plasty regarding outcomes of adaptive behavior skills. In addition, children treated for metopic synostosis showed results indicating shortcomings with adaptive behavior according to the full-scale, conceptual, and social composites (effect size, 0.53 to 0.61) relative to norms. Furthermore, attrition analysis revealed no significant differences between responders (rate, 80.2 percent) and nonresponders. CONCLUSION These results found that children treated for craniosynostosis display average adaptive behavior skills, and that the two surgical techniques used to treat sagittal synostosis did not differ in their behavioral outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
|
20
|
Yu M, Ma L, Yuan Y, Ye X, Montagne A, He J, Ho TV, Wu Y, Zhao Z, Sta Maria N, Jacobs R, Urata M, Wang H, Zlokovic BV, Chen JF, Chai Y. Cranial Suture Regeneration Mitigates Skull and Neurocognitive Defects in Craniosynostosis. Cell 2021; 184:243-256.e18. [PMID: 33417861 PMCID: PMC7891303 DOI: 10.1016/j.cell.2020.11.037] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 01/20/2023]
Abstract
Craniosynostosis results from premature fusion of the cranial suture(s), which contain mesenchymal stem cells (MSCs) that are crucial for calvarial expansion in coordination with brain growth. Infants with craniosynostosis have skull dysmorphology, increased intracranial pressure, and complications such as neurocognitive impairment that compromise quality of life. Animal models recapitulating these phenotypes are lacking, hampering development of urgently needed innovative therapies. Here, we show that Twist1+/- mice with craniosynostosis have increased intracranial pressure and neurocognitive behavioral abnormalities, recapitulating features of human Saethre-Chotzen syndrome. Using a biodegradable material combined with MSCs, we successfully regenerated a functional cranial suture that corrects skull deformity, normalizes intracranial pressure, and rescues neurocognitive behavior deficits. The regenerated suture creates a niche into which endogenous MSCs migrated, sustaining calvarial bone homeostasis and repair. MSC-based cranial suture regeneration offers a paradigm shift in treatment to reverse skull and neurocognitive abnormalities in this devastating disease.
Collapse
Affiliation(s)
- Mengfei Yu
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA; Key Laboratory of Oral Biomedical Research, Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Li Ma
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Yuan Yuan
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Xin Ye
- Key Laboratory of Oral Biomedical Research, Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Axel Montagne
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Jinzhi He
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Thach-Vu Ho
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Yingxi Wu
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Zhen Zhao
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Naomi Sta Maria
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Russell Jacobs
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Mark Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90033, USA
| | - Huiming Wang
- Key Laboratory of Oral Biomedical Research, Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Jian-Fu Chen
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Yang Chai
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA.
| |
Collapse
|
21
|
Spring-Assisted Strip Craniectomy Versus Cranial Vault Remodeling: Long-Term Psychological, Behavioral, and Executive Function Outcomes. J Craniofac Surg 2020; 31:2101-2105. [DOI: 10.1097/scs.0000000000006806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
22
|
Brown MN, Grames LM, Skolnick GB. Augmentative and Alternative Communication (AAC) Use Among Patients Followed by a Multidisciplinary Cleft and Craniofacial Team. Cleft Palate Craniofac J 2020; 58:324-331. [PMID: 32783478 DOI: 10.1177/1055665620947606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To establish preliminary data describing the number of patients who visit a multidisciplinary cleft and craniofacial team who use augmentative and alternative communication (AAC) supports. DESIGN This retrospective study consisted of chart reviews for all patients who visited a single site's multidisciplinary cleft and craniofacial team for 1 calendar year. SETTING A single multidisciplinary craniofacial team at a tertiary teaching hospital. PARTICIPANTS Four hundred sixty-four patients met the inclusion criteria for this study. Of these, 59.9% (n = 278) were male and 40.1% (n = 186) were female. RESULTS Of the sample population, 6.9% (n = 32) were AAC users as they received AAC intervention in a therapeutic context, while 93.1% (n = 432) were not. The AAC group had a mean age of 5.1 years (standard deviation [SD]: 4.2) and was 68.8% (n = 22) male. The non-AAC group had a mean age of 6.3 (SD: 4.9) and was 59.3% (n = 256) male. Within the AAC group, 40.6% (n = 13) were found to have an identified syndromic diagnosis in comparison to 17.6% (n = 76) of the non-AAC group (P = .003). CONCLUSIONS This is the first study to report the prevalence of AAC use among patients in the care of multidisciplinary cleft and craniofacial teams. Our findings suggest that a subset of craniofacial team patients may have complex communication disorders that require AAC supports. Craniofacial teams should be aware of resources available for these patients so that the patients' communication needs are met in the hospital, in school, and in the community.
Collapse
Affiliation(s)
| | | | - Gary B Skolnick
- 12275Washington University School of Medicine, St Louis, MO, USA.,Division of Plastic and Reconstructive Surgery, Department of Surgery, 7548Washington University in St Louis School of Medicine, The Cleft Palate-Craniofacial Institute, St Louis Children's Hospital, MO, USA
| |
Collapse
|
23
|
Nonsyndromic Craniosynostosis Is Associated with Increased Risk for Psychiatric Disorders. Plast Reconstr Surg 2020; 146:355-365. [PMID: 32740588 DOI: 10.1097/prs.0000000000007009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis. METHODS The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders. RESULTS Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders. CONCLUSIONS Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors). CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
|
24
|
Chieffo DPR, Arcangeli V, Bianchi F, Salerni A, Massimi L, Frassanito P, Tamburrini G. Single-suture craniosynostosis: is there a correlation between preoperative ophthalmological, neuroradiological, and neurocognitive findings? Childs Nerv Syst 2020; 36:1481-1488. [PMID: 32006097 DOI: 10.1007/s00381-020-04521-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In spite of literature data stating that children with single-suture craniosynostosis have an increased risk for neuropsychological deficits, no data are present clarifying the potential risk factors. METHODS All children with non-syndromic single-suture craniosynostosis operated on from January 2014 to January 2017 were enrolled. A comprehensive neurocognitive and neuro-ophthalmological evaluation was performed before surgery and 6 months after surgery. A further neurocognitive evaluation was performed 12 months after surgery. All children had a preoperative CT/MR study. RESULTS One hundred forty-two patients were enrolled; 87 are affected by sagittal craniosynostosis, 38 by trigonocephaly, and 17 by plagiocephaly. A global neurocognitive impairment was documented in 22/87 children with scaphocephaly, 5/38 children with trigonocephaly, and 6/17 children with anterior plagiocephaly. There was a significant relationship between results of the ophthalmological evaluation, global IQ, and CT findings at diagnosis (r = 0.296, p < 0.001; r =0.187, p 0.05). Though a significant recovery was documented after surgery, a persistence of eye coordination deficits was present at 6 months in 1 out of 3 children with abnormal preoperative exams. A significant correlation was found between pathological CT findings and persistence of below average neuro-ophthalmological and neurocognitive findings 6 months after surgery, as well as between CT findings and neurocognitive scores at the 1 year follow-up (r = 0.411; p < 0.01). CONCLUSION The presence of neuroradiological abnormalities appears to be related to both ophthalmological and neurocognitive deficits at diagnosis. This relationship is maintained in spite of the surgical treatment in children who show the persistence of ophthalmological and neurocognitive deficits during the follow-up.
Collapse
Affiliation(s)
- D P R Chieffo
- Institute of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - V Arcangeli
- Institute of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - F Bianchi
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy.
| | - A Salerni
- Institute of Ophthalmology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - L Massimi
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy
| |
Collapse
|
25
|
Zeytinoğlu-Saydam S, Özek MM, Marcus J, Crerand C. Behavioral functioning of school-aged children with non-syndromic craniosynostosis. Childs Nerv Syst 2020; 36:783-792. [PMID: 31823068 DOI: 10.1007/s00381-019-04439-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study investigated the risk for children with non-syndromic craniosynostosis to develop behavioral problems during school age determined by the type of craniosynostisis, age at first surgery, and number of surgeries. METHOD Final sample consisted of 43 children aged between 6 years and 8 months and 17 years and 1 month (M = 10 years and 5 months). Behavioral problems were assessed with Child Behavioral Checklist (CBCL). RESULTS Our sample had higher scores on the CBCL than the general population; specific elevations were observed including somatic complaints, aggressive behavior, social problems, attention problems, and thought problems and rule-breaking behavior. Behavioral functioning varied by number of surgical procedures, type of craniosynostosis, and age at first surgery. CONCLUSION For school-aged NSC children's behavioral functioning, diagnosis specific patterns especially impacted by the first age of the surgery and number of surgeries.
Collapse
Affiliation(s)
- Senem Zeytinoğlu-Saydam
- Department of Psychology, Özyeğin University, Çekmeköy Kampüsü Nişantepe Mahallesi Orman Sokak Çekmeköy, 34794, İstanbul, Turkey.
| | - M Memet Özek
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Acıbadem University, Altunizade Mahallesi, Yurtcan Sokağı No:1, Üsküdar, 34662, İstanbul, Turkey
| | - Justin Marcus
- College of Administrative Sciences and Economics, Koç University, Rumelifeneri Mahallesi, Rumelifeneri Yolu, Sarıyer, 34450, Istanbul, Turkey
| | - Canice Crerand
- Department of Pediatrics, The Ohio State University College of Medicine, and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| |
Collapse
|
26
|
An Investigation of Brain Functional Connectivity by Form of Craniosynostosis. J Craniofac Surg 2020; 30:1719-1723. [PMID: 31022138 DOI: 10.1097/scs.0000000000005537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Long-term neurocognitive sequelae of nonsyndromic craniosynostosis (NSC) patients are just beginning to be clarified. This study uses functional MRI (fMRI) to determine if there is evidence of altered brain functional connectivity in NSC, and whether these aberrations vary by form of synostosis. METHODS Twenty adolescent participants with surgically treated NSC (10 sagittal synostosis, 5 right unilateral coronal synostosis [UCS], 5 metopic synostosis [MSO]) were individually matched to controls by age, gender, and handedness. A subgroup of MSO was classified as severe metopic synostosis (SMS) based on the endocranial bifrontal angle. Resting state fMRI was acquired in a 3T Siemens TIM Trio scanner (Erlangen, Germany), and data were motion corrected and then analyzed with BioImage Suite (Yale School of Medicine). Resulting group-level t-maps were cluster corrected with nonparametric permutation tests. A region of interest analysis was performed based on the left Brodmann's Areas 7, 39, and 40. RESULTS Sagittal synostosis had decreased whole-brain intrinsic connectivity compared to controls in the superior parietal lobules and the angular gyrus (P = 0.071). Unilateral coronal synostosis had decreased intrinsic connectivity throughout the prefrontal cortex (P = 0.031). The MSO cohort did not have significant findings on intrinsic connectivity, but the SMS subgroup had significantly decreased connectivity among multiple subcortical structures. CONCLUSION Sagittal synostosis had decreased connectivity in regions associated with visuomotor integration and attention, while UCS had decreased connectivity in circuits crucial in executive function and cognition. Finally, severity of metopic synostosis may influence the degree of neurocognitive aberration. This study provides data suggestive of long-term sequelae of NSC that varies by suture type, which may underlie different phenotypes of neurocognitive impairment.
Collapse
|
27
|
Kljajić M, Maltese G, Tarnow P, Sand P, Kölby L. Sustained attention and vigilance of children treated for sagittal and metopic craniosynostosis. Child Neuropsychol 2019; 26:475-488. [DOI: 10.1080/09297049.2019.1682130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marizela Kljajić
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Giovanni Maltese
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Sand
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
28
|
Verlut I, Mottolese C, Szathmari A, Banvillet E, Poncet A, Blache A, Rousselle C, Gleizal A, Paulus C, Di Rocco F. [Neuropsychological consequences of craniosynostosis: Non-syndromic scaphocephaly]. Neurochirurgie 2019; 65:330-336. [PMID: 31585152 DOI: 10.1016/j.neuchi.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scaphocephaly increases the rate of some modifications of cognitive and mood profile in a manner that remains to be elucidated. OBJECTIVE We aimed to describe the impact of scaphocephaly on neuropsychological profile and more particularly on the executive functions. PATIENTS AND METHODS An experimental group of 19 children older than 5 years, operated on for scaphocephaly, was compared with a control group of 10 children operated on for trigonocephaly, using IQ tasks, attention tasks and mood scales. A group of 6 children from 2 to 4 years old, operated on for scaphocephaly, and a group of 6 children with non-operated scaphocephaly are also described. RESULTS Both the experimental group and the control group showed unchanged IQ, whereas attention deficit and anxiety disorder were more frequent in the experimental group. Cognitive profiles differed between groups, with a higher rate of impaired inhibitory control of visual processing in the scaphocephaly group, contrasting with a higher rate of impaired auditory verbal working memory in the trigonocephaly group. Comparable profiles were also found in groups of younger or non-operated children with scaphocephaly. CONCLUSIONS Many children with scaphocephaly must cope with a specific neuropsychological profile throughout development. This study suggests the interest for these children and their families of specific follow-up in reference centers.
Collapse
Affiliation(s)
- I Verlut
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France.
| | - C Mottolese
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Szathmari
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - E Banvillet
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Poncet
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Blache
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - C Rousselle
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - A Gleizal
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - C Paulus
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| | - F Di Rocco
- Service de neurochirurgie, centre de référence des malformations craniofaciales, hôpital Femme-Mère-Enfant, université de Lyon 1, 59, boulevard Pinel, 69500 Bron, France
| |
Collapse
|
29
|
|
30
|
Mandela R, Bellew M, Chumas P, Nash H. Impact of surgery timing for craniosynostosis on neurodevelopmental outcomes: a systematic review. J Neurosurg Pediatr 2019; 23:442-454. [PMID: 30684935 DOI: 10.3171/2018.10.peds18536] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are currently no guidelines for the optimum age for surgical treatment of craniosynostosis. This systematic review summarizes and assesses evidence on whether there is an optimal age for surgery in terms of neurodevelopmental outcomes. METHODS The databases MEDLINE, PsycINFO, CINAHL, Embase + Embase Classic, and Web of Science were searched between October and November 2016 and searches were repeated in July 2017. According to PICO (participants, intervention, comparison, outcome) criteria, studies were included that focused on: children diagnosed with nonsyndromic craniosynostosis, aged ≤ 5 years at time of surgery; corrective surgery for nonsyndromic craniosynostosis; comparison of age-at-surgery groups; and tests of cognitive and neurodevelopmental postoperative outcomes. Studies that did not compare age-at-surgery groups (e.g., those employing a correlational design alone) were excluded. Data were double-extracted by 2 authors using a modified version of the Cochrane data extraction form. RESULTS Ten studies met the specified criteria; 5 found a beneficial effect of earlier surgery, and 5 did not. No study found a beneficial effect of later surgery. No study collected data on length of anesthetic exposure and only 1 study collected data on sociodemographic factors. CONCLUSIONS It was difficult to draw firm conclusions from the results due to multiple confounding factors. There is some inconclusive evidence that earlier surgery is beneficial for patients with sagittal synostosis. The picture is even more mixed for other subtypes. There is no evidence that later surgery is beneficial. The authors recommend that future research use agreed-upon parameters for: age-at-surgery cut-offs, follow-up times, and outcome measures.
Collapse
|
31
|
Abstract
Craniosynostosis is one of the most common craniofacial conditions treated by neurologic and plastic surgeons. In addition to disfigurement, children with craniosynostosis experience significant cognitive dysfunction later in life. Surgery is performed in infancy to correct skull deformity; however, the field is at a crossroads regarding the best approach for correction. Since the cause of brain dysfunction in these patients has remained uncertain, the role and type of surgery might have in attenuating the later-observed cognitive deficits through impact on the brain has been unclear. Recently, however, advances in imaging such as event-related potentials, diffusion tensor imaging, and functional MRI, in conjunction with more robust clinical studies, are providing important insight into the potential etiologies of brain dysfunction in syndromic and nonsyndromic craniosynostosis patients. This review aims to outline the cause(s) of such brain dysfunction including the role extrinsic vault constriction might have on brain development and the current evidence for an intrinsic modular developmental error in brain development. Illuminating the cause of brain dysfunction will identify the role of surgery can play in improving observed functional deficits and thus direct optimal primary and adjuvant treatment.
Collapse
|
32
|
Osborn AJ, Roberts RM, Mathias JL, Anderson PJ, Flapper WJ. Cognitive, behavioral and psychological functioning in children with metopic synostosis: a meta-analysis examining the impact of surgical status. Child Neuropsychol 2018; 25:263-277. [PMID: 29482450 DOI: 10.1080/09297049.2018.1441821] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Neurodevelopmental delays are known to occur in children with metopic synostosis, but it is presently unclear whether the cognitive, behavioral and psychological outcomes of children with metopic synostosis differ to those of their healthy peers. This meta-analysis consolidated data from 17 studies (published prior to August 2017) that examined the cognitive, behavioral and psychological outcomes of children (n = 666; aged ≤19 yrs) with metopic synostosis. Hedges'g (gw) effect sizes compared the outcomes of samples with metopic synostosis (unoperated, operated) to healthy controls or normative data and, where available, the prevalence of problems/disorders was calculated. Children with unoperated metopic synostosis performed significantly worse than their healthy peers on measures of: general cognition (gw = -.38), motor functioning, (gw = -.81), and verbal (gw = -.82) and visuospatial (gw = -.92) abilities. Children with operated metopic synostosis performed significantly worse on measures of motor functioning (gw = -.45), visuospatial skills (gw = -.32), attention (gw = -.50), executive functioning (gw = -.36), arithmetic ability (gw = -.37), and behavior (gw = -.34). Cognitive, behavioral, and psychological problems were prevalent, but variable. Overall, the cognitive, behavioral, and psychological outcomes of children with metopic synostosis are generally worse than their healthy peers, regardless of surgical status. However, research is sparse, samples small, controls are rarely recruited, and the severity of metopic synostosis often not stated. Nevertheless, the findings suggest that children with metopic synostosis are likely to experience a variety of negative outcomes and should therefore receive ongoing monitoring and support.
Collapse
Affiliation(s)
- A J Osborn
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - P J Anderson
- b The Australian Craniofacial Unit , Women's and Children's Hospital , North Adelaide , Australia
| | - W J Flapper
- b The Australian Craniofacial Unit , Women's and Children's Hospital , North Adelaide , Australia
| |
Collapse
|
33
|
A Craniometric Analysis of Cranial Base and Cranial Vault Differences in Patients With Metopic Craniosynostosis. J Craniofac Surg 2017; 28:2030-2035. [DOI: 10.1097/scs.0000000000003888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
34
|
Abstract
OBJECTIVE Previous studies have shown that infants and young children with single-suture craniosynostosis (SSC) perform more poorly on tests of visuomotor function than children without SSC. However, previous studies are limited by small sample sizes and little is known about the persistence of visuomotor problems into the school-age years. The aim of this study was to compare visuomotor function in children with and without SSC at the beginning of elementary school. METHODS The study included 179 children with SSC (cases) and 183 children without SSC (controls). Visuomotor function was measured by the NEPSY-II Arrows, the Purdue Pegboard Test, and the Beery-Buktenica Developmental Test of visual-motor integration. Case-control differences were estimated using linear regression, adjusted for age, sex, socioeconomic status, and maternal IQ. RESULTS Cases scored more poorly on all measures of visuomotor function, although the magnitude of case-control differences varied across measures. The greatest differences were observed for the Purdue Pegboard Test, with an average adjusted difference of -0.2 to -0.4 SD points (p-values ranged from .008 to .05). Case-control differences were small in magnitude for other measures of visuomotor function, ranging from -0.01 to -0.1 SD points (p-values ranged from .22 to .88). CONCLUSION Children with SSC experienced deficits in manual dexterity into the school-age years but were similar to children without SSC on measures of visual processing. These findings advocate for the assessment of fine-motor function as part of school readiness evaluations in children with SSC.
Collapse
|