Cognitive Development of Children with Craniosynostosis

Chiari malformation type I and craniosynostosis in adults: Retrospective analysis over a 10 year period in a tertiary care Centre

BACKGROUND

Chiari malformation type 1 (CM1) pathophysiology remains uncertain. One theory involves small posterior fossa volumes leading to tonsillar herniation. Craniosynostosis causes suture fusion, which can limit skull growth, and has been investigated in paediatric CM1 cohorts. We aimed to identify the prevalence of concurrent craniosynostosis in adult CM1 patients.

METHODS

Surgically managed CM1 patients were identified from a pre-existing Edinburgh neurosurgical centres database spanning 10 years. Patients aged 16 years of age or older had their case notes reviewed retrospectively. Cross sectional imaging identified and classified craniosynostosis, tonsillar herniation and the presence of hydrocephalus or syrinxes.

RESULTS

35 cases met inclusion criteria. Seven cases (20%) had craniosynostosis, all of which were sagittal synostosis. There was no significant association between the presence of craniosynostosis and the degree of tonsillar herniation, presence of hydrocephalus or syrinx formation.

CONCLUSION

This is the first study to evaluate the prevalence of craniosynostosis in a cohort of surgically managed adult CM1 patients. Future studies should potentially investigate whether conservatively managed adult CM1 patients have similar rates of craniosynostosis and also lack significant associations to known CM1-related complications.

Defining a Taxonomical Map for Craniosynostoses: An Integrated Nomenclature for Interdisciplinary Workflow and Problem Mapping in Craniosynostoses Management: A Feasibility Study

Craniosynostoses is a complex clinical and management challenge. This is further complicated by varying phenotypes and specific challenges. Most complex craniosynostoses are approached and managed the same way despite the clinical variability. The goals for craniofacial surgery are common, but the nomenclature based on phenotype, genotype, sutural involvement, or syndromic nature does not shed light on the management workflow. The descriptive diagnosis and terminologies do not highlight the priorities and the operational issues, and most specialists dealing with these conditions remain in their field of tunnelled vision. In this article, the authors propose a concept of categorization based on initial patient presentation. In addition, the etiology and the treatment status, if available, are incorporated along with the presentation. The utility of our proposed categorization is to create a goal-based universal language among various specialists involved.

Cranial Suture Regeneration Mitigates Skull and Neurocognitive Defects in Craniosynostosis

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.

Behavioral functioning of school-aged children with non-syndromic craniosynostosis

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.