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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.
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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
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2
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Kalmar CL, Malphrus EL, Blum JD, Kosyk MS, Zapatero ZD, Heuer GG, Bartlett SP, Taylor JA, Lang SS, Swanson JW. Intracranial Pressure Patterns in Children with Sagittal Craniosynostosis. Plast Reconstr Surg 2024; 154:135e-145e. [PMID: 37285193 DOI: 10.1097/prs.0000000000010797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Elevated intracranial pressure (ICP) in sagittal craniosynostosis has a wide spectrum of reported incidence, and patterns are not well understood across infancy and childhood. Characterizing the natural history of ICP in this population may clarify risks for neurocognitive delay and inform treatment decisions. METHODS Infants and children with sagittal craniosynostosis and unaffected control subjects were prospectively evaluated with spectral-domain optical coherence tomography from 2014 to 2021. Elevated ICP was determined based on previously validated algorithms using retinal optical coherence tomography parameters. RESULTS Seventy-two patients with isolated sagittal craniosynostosis and 25 control subjects were evaluated. Overall, 31.9% ( n = 23) of patients with sagittal craniosynostosis had evidence of ICP greater than or equal to 15 mmHg, and 27.8% ( n = 20) of patients had ICP greater than or equal to 20 mmHg. Children with sagittal craniosynostosis younger than 6 months were more likely to have normal ICP (88.6% <15 mmHg; 91.4% <20 mmHg) than those aged between 6 and 12 months (54.5%, P = 0.013; 54.5%, P = 0.005) than those older than 12 months (46.2%, P < 0.001; 53.8%, P = 0.001). ICP was directly correlated with severity of scaphocephaly ( P = 0.009). No unaffected control subjects at any age exhibited retinal thickening suggestive of elevated ICP. CONCLUSION Elevated ICP is rare in isolated sagittal craniosynostosis younger than 6 months, but it becomes significantly more common after 6 months of age, and may correlate with severity of scaphocephaly. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
| | | | - Jessica D Blum
- From the Divisions of Plastic and Reconstructive Surgery
| | | | | | | | | | - Jesse A Taylor
- From the Divisions of Plastic and Reconstructive Surgery
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3
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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.
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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.
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4
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Kurniawan MS, Kamst NW, Mathijssen IM, Erler NS, van Veelen MLC. Child-Patient Perspective on Results After Correction of Sagittal Synostosis and the Difference Between Child-Patient and Parent's Perspectives. J Craniofac Surg 2024; 35:1040-1044. [PMID: 38722327 PMCID: PMC11122732 DOI: 10.1097/scs.0000000000010263] [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] [Received: 05/08/2023] [Accepted: 04/03/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE This study assesses the level of child-patient satisfaction with the surgical result after scaphocephaly correction and the difference between child-patient and parents' perspectives. METHODS A questionnaire was sent out to children between 6 and 18 years old with isolated sagittal synostosis, who had undergone either a frontobiparietal remodeling or extended strip craniotomy, and separately to their parents. RESULTS The questionnaire was completed by 96 patients, 81.2% of the patients considered their head to be similar or slightly different from others. Despite the majority being satisfied with the outcome, 33% would change the shape of their head if they could. Patients who underwent extended strip craniotomy wanted to change the back of their head more often ( P = 0.002), whereas patients who underwent frontobiparietal remodeling wanted to change their forehead ( P = 0.005). The patients' own perspective on head shape was independent of the cephalic index (CI). However, patients with a relatively narrow CI received more remarks from others about their heads ( P = 0.038). Parent and child agreement was 49.7% on average. Differences between child-patients and parents were found in reporting adaptive behavior. CONCLUSION The majority of patients were satisfied with the outcome of their intervention. The child's perspective seems to be a valuable addition to evaluate sagittal synostosis surgery as it is independent of the CI and differentiates between different surgical techniques. In addition, the patient's perspective is comparable to the parent's perspective, but gives more details on adaptive behavior.
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Affiliation(s)
- Melissa S.I.C Kurniawan
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center Rotterdam
- Department of Neurosurgery, Erasmus University Medical Center Rotterdam
| | - Nathalie W. Kamst
- Department of Neurosurgery, Erasmus University Medical Center Rotterdam
| | - Irene M.J. Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center Rotterdam
| | - Nicole S. Erler
- Department of Biostatistics, Erasmus University Medical Center Rotterdam
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, The Netherlands
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5
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Gamarra V, Pearson GD, Drapeau A, Pindrik J, Crerand CE, Rabkin AN, Khansa I. Prospective Evaluation of Health-Related Quality-of-Life in Children with Craniosynostosis. Cleft Palate Craniofac J 2024:10556656241234562. [PMID: 38380879 DOI: 10.1177/10556656241234562] [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: 02/22/2024] Open
Abstract
OBJECTIVE To investigate health-related quality of life (HRQL) in children aged 2 to 7 years, who have undergone surgery for craniosynostosis. DESIGN Cross-sectional survey. SETTING A tertiary pediatric academic medical center. PARTICIPANTS Children with craniosynostosis who underwent surgical correction, and who were 2-7 years old at the time of the study. Children from families that did not speak English were excluded. INTERVENTIONS Caregivers were asked to fill out the Pediatric Quality of Life Inventory (PedsQL) Core Parent Report and the PedsQL Cognitive Functioning Scale. MAIN OUTCOME MEASURES PedsQL: Psychosocial Health Summary Score, Physical Health Summary Score, Total Core Score, Cognitive Functioning Scale Score. Scores range from 0 to 100, with higher scores reflecting greater QoLSubject factors: comorbidities, syndromic status, type of craniosynostosis, type of surgery. RESULTS The study included 53 subjects, of whom 13.2% had a syndrome. Core and cognitive scores did not depend on presence of a syndrome or suture involved. Subjects who underwent posterior cranial distraction achieved higher Total Core Scores than subjects who underwent open vault remodeling. Among subjects with sagittal craniosynostosis, there was a tendency for higher scores among children who underwent minimally-invasive surgery compared to those who underwent open vault remodeling. CONCLUSIONS This study demonstrates similar HRQL among children with and without a syndrome, higher HRQL among children undergoing posterior cranial distraction than those undergoing open vault remodeling, and trends towards higher HRQL in children with sagittal craniosynostosis who underwent minimally-invasive surgery compared to those who underwent open vault remodeling.
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Affiliation(s)
- Valeria Gamarra
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gregory D Pearson
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Annie Drapeau
- Section of Neurosurgery, Health Sciences Centre and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan Pindrik
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Canice E Crerand
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ari N Rabkin
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ibrahim Khansa
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Division of Plastic Surgery, Texas Children's Hospital - North Austin, Austin, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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6
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Spazzapan P, Velnar T. Isolated Sagittal Craniosynostosis: A Comprehensive Review. Diagnostics (Basel) 2024; 14:435. [PMID: 38396475 PMCID: PMC10887665 DOI: 10.3390/diagnostics14040435] [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: 01/02/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is characterised by a pronounced head shape, often referred to as scaphocephaly. Asymmetry of the face and head, protrusion of the fontanel, and increased intracranial pressure are common clinical manifestations. Early recognition of these features is crucial for early intervention, and understanding the aetiology is, therefore, essential. Although the exact cause remains unclear, genetic factors are thought to play an important role. Mutations in genes such as FGFR2 and FGFR3, which disrupt the normal development of the skull, are suspected. Environmental factors and various insults during pregnancy can also contribute to the occurrence of the disease. An accurate diagnosis is crucial for treatment. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and three-dimensional reconstructions play a crucial role in visualising the prematurely fused sagittal suture. Clinicians also rely on a physical examination and medical history to confirm the diagnosis. Early detection allows for quick intervention and better treatment outcomes. The treatment of sagittal craniosynostosis requires a multidisciplinary approach that includes neurosurgery, craniofacial surgery, and paediatric care. Traditional treatment consists of an open reconstruction of the cranial vault, where the fused suture is surgically released to allow normal growth of the skull. However, advances in minimally invasive techniques, such as endoscopic strip craniectomy, are becoming increasingly popular due to their lower morbidity and shorter recovery times. This review aims to provide a comprehensive overview of sagittal craniosynostosis, highlighting the aetiology, clinical presentation, diagnostic methods, and current treatment options.
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Affiliation(s)
- Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Alma Mater Europaea ECM, 2000 Maribor, Slovenia
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7
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Edwards-Bailey L, Piggott K, Dalton L, Horton J, Parks C, White S, Wright G, Kearney A. The Craniofacial Collaboration UK: Developmental Outcomes in 7- and 10-Year-Old Children With Metopic Synostosis. J Craniofac Surg 2024; 35:96-103. [PMID: 38294298 DOI: 10.1097/scs.0000000000009803] [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: 07/20/2022] [Accepted: 08/26/2023] [Indexed: 02/01/2024] Open
Abstract
The Craniofacial Collaboration (CC-UK) is a shared initiative across the Psychology teams attached to 4 highly specialized craniofacial centers in the United Kingdom. The CC-UK aims to address key limitations in the existing craniofacial literature by analyzing data for homogenous samples of children with craniosynostosis. This article presents the fifth wave of CC-UK data collection, focused on 7- and 10-year olds who have undergone primary corrective surgery for metopic synostosis (MS). Data for children with sagittal synostosis and MS have previously been presented at 3 and 5 years. This paper continues to build on this with consideration to older age groups, presenting the first CC-UK analysis of cognitive assessment data using the Wechsler Abbreviated Scale of Intelligence-Second Edition. Results show that the majority of children with MS fall within the average ranges across behavioral and neurodevelopmental domains. However, several domains indicated a trend of heightened concern when compared with normative data, particularly for parent-reported outcomes, suggesting that there may be some subtle difficulties for children with MS. Consideration of how these findings compare with that of previous CC-UK analyses is explored. Further, implications for clinical practice and future research are considered, with the need for longitudinal analyses, as well as data from multiple perspectives (eg, school, parents, and self) at older age points to establish patterns over time. Through collaboration across the highly specialized craniofacial centers, the CC-UK hopes to work toward this goal moving forward.
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Affiliation(s)
| | - Katie Piggott
- Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Louise Dalton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Jo Horton
- Craniofacial Unit, Birmingham Women's and Children's Hospital, Birmingham
| | - Christopher Parks
- Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Samuel White
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Gillian Wright
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Anna Kearney
- Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
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8
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Selvaggi G, Maltese G, Kölby L, Elander A, Tarnow P, Kljajić M. Ethical Considerations in Surgery for Single-suture Craniosynostosis. J Craniofac Surg 2023; 34:1922-1926. [PMID: 37552119 DOI: 10.1097/scs.0000000000009590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023] Open
Abstract
Singe-suture craniosynostosis (SSC) describes the premature fusion of one cranial suture, which restricts cranial growth and consequently results in unaffected regions presenting a compensatory expansion. Surgery can redistribute intracranial volume, reduce the risk of elevated intracranial pressure, and improve head shape, potentially leading to improved neurocognitive function and social acceptance. However, there is limited evidence that surgery for SSC improves neurocognitive function and social acceptance. Given the inherent surgical risks and uncertainty of outcomes, the conditions under which this surgery should be allowed remain uncertain. Here, we discuss ethical questions regarding the permissibility of surgery, value of neurocognitive function and social acceptance, research ethics associated with SSC, patient autonomy and parental roles, and the process of recommending surgery and obtaining consent. Because surgery for SSC has become a routine procedure, its practice now presents a relatively low risk of complications. Furthermore, having acquired an understanding of the risks associated with this surgery, such knowledge fulfils the principle of non-maleficence although not beneficence. Thus, we advocate that surgery should only be offered within Institutional Review Board-approved research projects. In these situations, decisions concerning enrollment in scientific research involves health care providers and parents or guardians of the child, with the former acting as gate-keepers upon recognition of a lack of coping skills on the part of the parent or guardian in dealing with unforeseen outcomes. To minimize associated surgical risks and maximize its benefits, there exists a moral obligation to refer patients only to highly specialized centers.
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Affiliation(s)
- Gennaro Selvaggi
- University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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9
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Michaëlsson I, Skoglund T, Hallén T, Olsson R, Maltese G, Tarnow P, Bhatti-Søfteland M, Zetterberg H, Blennow K, Kölby L. Circulating Brain-Injury Markers After Surgery for Craniosynostosis. World Neurosurg 2023; 173:e593-e599. [PMID: 36863456 DOI: 10.1016/j.wneu.2023.02.102] [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] [Received: 01/09/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Historically, there have been few quantitative methods for effectively evaluating outcomes after surgery for craniosynostosis. In this prospective study, we assessed a novel approach for detecting possible postsurgery brain injury in patients with craniosynostosis. METHODS We included consecutive patients operated on for sagittal (pi-plasty or craniotomy combined with springs) or metopic (frontal remodeling) synostosis at the Craniofacial Unit at Sahlgrenska University Hospital, Gothenburg, Sweden, from January 2019 to September 2020. Plasma concentrations of the brain-injury biomarkers neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and tau were measured immediately before induction of anesthesia, immediately before and after surgery, and on the first and the third postoperative days using single-molecule array assays. RESULTS Of the 74 patients included, 44 underwent craniotomy combined with springs for sagittal synostosis, 10 underwent pi-plasty for sagittal synostosis, and 20 underwent frontal remodeling for metopic synostosis. Compared with baseline, GFAP level showed a maximal significant increase at day 1 after frontal remodeling for metopic synostosis and pi-plasty (P = 0.0004 and P = 0.003, respectively). By contrast, craniotomy combined with springs for sagittal synostosis showed no increase in GFAP. For neurofilament light, we found a maximal significant increase at day 3 after surgery for all procedures, with significantly higher levels observed after frontal remodeling and pi-plasty compared with craniotomy combined with springs (P < 0.001). CONCLUSIONS These represent the first results showing significantly increased plasma levels of brain-injury biomarkers after surgery for craniosynostosis. Furthermore, we found that more extensive cranial vault procedures resulted in higher levels of these biomarkers relative to less extensive procedures.
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Affiliation(s)
- Isak Michaëlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tobias Hallén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Olsson
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giovanni Maltese
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Madiha Bhatti-Søfteland
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at UCL, London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
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10
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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.
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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
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11
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Cross C, Khonsari RH, Patermoster G, Arnaud E, Larysz D, Kölby L, Johnson D, Ventikos Y, Moazen M. A Computational Framework to Predict Calvarial Growth: Optimising Management of Sagittal Craniosynostosis. Front Bioeng Biotechnol 2022; 10:913190. [PMID: 35685092 PMCID: PMC9170984 DOI: 10.3389/fbioe.2022.913190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
The neonate skull consists of several bony plates, connected by fibrous soft tissue called sutures. Premature fusion of sutures is a medical condition known as craniosynostosis. Sagittal synostosis, caused by premature fusion of the sagittal suture, is the most common form of this condition. The optimum management of this condition is an ongoing debate in the craniofacial community while aspects of the biomechanics and mechanobiology are not well understood. Here, we describe a computational framework that enables us to predict and compare the calvarial growth following different reconstruction techniques for the management of sagittal synostosis. Our results demonstrate how different reconstruction techniques interact with the increasing intracranial volume. The framework proposed here can be used to inform optimum management of different forms of craniosynostosis, minimising the risk of functional consequences and secondary surgery.
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Affiliation(s)
- Connor Cross
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Neurosurgery, Craniofacial Surgery Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Giovanna Patermoster
- Department of Neurosurgery, Craniofacial Surgery Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Arnaud
- Department of Neurosurgery, Craniofacial Surgery Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dawid Larysz
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury in Olsztyn, Prof. St. Popowski Regional Specialized Children's Hospital, Olsztyn, Poland
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospital, Oxford, United Kingdom
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, United Kingdom
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12
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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.
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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.
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13
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Cross C, Khonsari RH, Larysz D, Johnson D, Kölby L, Moazen M. Predicting and comparing three corrective techniques for sagittal craniosynostosis. Sci Rep 2021; 11:21216. [PMID: 34707183 PMCID: PMC8551239 DOI: 10.1038/s41598-021-00642-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
Sagittal synostosis is the most occurring form of craniosynostosis, resulting in calvarial deformation and possible long-term neurocognitive deficits. Several surgical techniques have been developed to correct these issues. Debates as to the most optimal approach are still ongoing. Finite element method is a computational tool that's shown to assist with the management of craniosynostosis. The aim of this study was to compare and predict the outcomes of three reconstruction methods for sagittal craniosynostosis. Here, a generic finite element model was developed based on a patient at 4 months of age and was virtually reconstructed under all three different techniques. Calvarial growth was simulated to predict the skull morphology and the impact of different reconstruction techniques on the brain growth up to 60 months of age. Predicted morphology was then compared with in vivo and literature data. Our results show a promising resemblance to morphological outcomes at follow up. Morphological characteristics between considered techniques were also captured in our predictions. Pressure outcomes across the brain highlight the potential impact that different techniques have on growth. This study lays the foundation for further investigation into additional reconstructive techniques for sagittal synostosis with the long-term vision of optimizing the management of craniosynostosis.
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Affiliation(s)
- Connor Cross
- Department of Mechanical Engineering, University College London, London, UK
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, School of Medicine, Necker - Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France
| | - Dawid Larysz
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury in Olsztyn. Ul, Zolnierska 18a, 10-561, Olsztyn, Poland
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, UK.
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14
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Galiay L, Hennocq Q, Cross C, Arnaud E, Larysz D, Kölby L, Paternoster G, Khonsari RH, Moazen M. Management of sagittal craniosynostosis: Morphological comparison of 8 surgical techniques. Br J Oral Maxillofac Surg 2021; 60:499-506. [DOI: 10.1016/j.bjoms.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022]
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15
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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.
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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
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16
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Discussion: Long-Term Neurocognitive Outcomes of Spring-Assisted Surgery versus Cranial Vault Remodeling for Sagittal Synostosis. Plast Reconstr Surg 2021; 147:672-673. [PMID: 33620935 DOI: 10.1097/prs.0000000000007692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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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.
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18
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Smetona J, Junn A, Dinis J, Lopez J, Lu X, Alperovich M, Persing JA. Current Controversies in Craniosynostosis Research: A Tribute to Ian Jackson. J Craniofac Surg 2021; 32:1199-1203. [PMID: 33306645 DOI: 10.1097/scs.0000000000007331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- John Smetona
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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19
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Schulz M, Liebe-Püschel L, Seelbach K, Paulikat L, Fehlhaber F, Schwarz K, Blecher C, Thomale UW. Quantitative and qualitative comparison of morphometric outcomes after endoscopic and conventional correction of sagittal and metopic craniosynostosis versus control groups. Neurosurg Focus 2021; 50:E2. [PMID: 33794497 DOI: 10.3171/2021.1.focus20988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical correction for sagittal and metopic craniosynostosis (SCS and MCS) aims to alter the abnormal cranial shape to resemble that of the normal population. The achieved correction can be assessed by morphometric parameters. The purpose of the presented study was to compare craniometric parameters of control groups to those same parameters after endoscopic and conventional (open) correction. METHODS The authors identified 4 groups of children undergoing surgical treatment for either SCS or MCS, with either endoscopic (SCS, n = 17; MCS, n = 16) or conventional (SCS, n = 29; MCS, n = 18) correction. In addition, normal control groups of nonaffected children who were 6 (n = 30) and 24 (n = 18) months old were evaluated. For all groups, several craniometric indices calculated from 3D photographs were compared for quantitative analysis. For qualitative comparison, averages of all 3D photographs were generated for all groups and superimposed to visualize relative changes. RESULTS For children with SCS, the cephalic index and coronal circumference index significantly differed preoperatively from those of the 6-month normal controls. The respective postoperative values were similar to those of the 24-month normal controls after both endoscopic and conventional correction. Similarly, for children with MCS, indices for circumference and diagonal dimension that were significantly different preoperatively became nonsignificantly different from those of 24-month normal controls after both endoscopic and conventional correction. The qualitative evaluation of superimposed average 3D head shapes confirmed changes toward normal controls after both treatment modalities for SCS and MCS. However, in SCS, the volume gain, especially in the biparietal area, was more noticeable after endoscopic correction, while in MCS, relative volume gain of the bilateral forehead was more pronounced after conventional correction. The average 3D head shapes matched more homogeneously with the average of normal controls after endoscopic correction for SCS and after conventional correction for MCS. CONCLUSIONS This quantitative analysis confirms that the performed surgical techniques of endoscopic and conventional correction of SCS and MCS alter the head shape toward those of normal controls. However, in a qualitative evaluation, the average head shape after endoscopic technique for SCS and conventional correction for MCS appears to be closer to that of normal controls than after the alternative technique. This study reports on morphometric outcomes after craniosynostosis correction. Only an assessment of the whole multiplicity of outcome parameters based on multicenter data acquisition will allow conclusions of superiority of one surgical technique.
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Affiliation(s)
| | | | - Karl Seelbach
- 1Pediatric Neurosurgery, Charité Universitätsmedizin Berlin
| | - Laura Paulikat
- 1Pediatric Neurosurgery, Charité Universitätsmedizin Berlin
| | - Felix Fehlhaber
- 2Fraunhofer Institute for Production Systems and Design Technology (IPK); and
| | - Karin Schwarz
- 1Pediatric Neurosurgery, Charité Universitätsmedizin Berlin
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20
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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.
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21
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Di Rocco F, Gleizal A, Szathmari A, Beuriat P, Paulus C, Mottolese C. Sagittal suture craniosynostosis or craniosynostoses? The heterogeneity of the most common premature fusion of the cranial sutures. Neurochirurgie 2019; 65:232-238. [DOI: 10.1016/j.neuchi.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
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22
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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
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23
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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.
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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
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