Early beaten-copper pattern: its long-term effect on intelligence quotients in 95 children with craniosynostosis

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Object

The aim of this study was to analyze the presence of beaten-copper patterns (BCPs) in children with craniosynostosis before 18 months of age and its association with their IQ at a later age.

Methods

The authors conducted a retrospective analysis of 538 cephalograms (obtained at a mean patient age of 1.16 years) from 95 patients. The BCP location and percentage of brain surface area covered were related to patient IQ scores obtained by the same psychologist using the Snijders–Oomen Nonverbal Intelligence Test–Revised, 51/2–17, and the Wechsler Preschool and Primary Scale of Intelligence–Revised.

Results

As much as 71.6% of patients presented with a BCP before 18 months of age (mean surface area of BCP 20.3%, 93% of patients presented with bilateral BCPs). The mean IQ was 95 ± 21.3 (range 50–136) at a mean patient age of 8.4 ± 2.59 years. There was a significant increase in the surface area covered by BCPs in the first 3 years of life (p < 0.001) and a significant difference in IQs between syndromic (30 cases, mean IQ 88.9) and nonsyndromic craniosynostosis cases (54 cases, mean IQ 98.9, p = 0.03). No significant correlation was found between IQ and the appearance of BCPs on presurgery radiographs (Pearson correlation coefficient = 0.143, p = 0.19) or their location (Spearman rank correlation coefficient = 0.091, p = 0.45). The BCPs appeared predominantly in the occipital region (41.1%).

Conclusions

Although the radiographic appearance of a BCP before the age of 18 months is an uncommon finding in healthy children, a craniosynostosis study group showed a preoperative BCP incidence of 71.6% and an increased incidence during the period of rapid brain expansion in the first 3 years of life. Note, however, that the presence of such a pattern had no significant long-term effect on patient intelligence levels.

Abbreviations used in this paper: BCP = beaten-copper patterns; ICP = intracranial pressure.

Article Information

Address correspondence to: Jacques van der Meulen, M.D., Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Dr Molewaterplein 60, Rotterdam 3015 GJ, The Netherlands. email: j.vandermeulen@erasmusmc.nl.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Lateral cephalogram demonstrating a generalized BCP.

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    Photograph depicting the gyral pattern on the surface of the inner cortex of frontal bone.

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    Lateral cephalograms revealing the total intracranial area (left, A) and the intracranial area marked as a BCP (right, B). Area B/A × 100% = 9.8% BCP in this case.

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    Bar graph demonstrating the IQ distribution in syndromic (light bars) and nonsyndromic (dark bars) cases. The y axis represents percentage of cases; the x axis, the IQs.

  • View in gallery

    Bar graph showing the percentage of BCPs per intracranial location as seen on lateral skull radiographs.

  • View in gallery

    Graph revealing the spreading pattern of BCP percentages over the years compared with the growth rate of the brain.

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