Long-term neuropsychological development in single-suture craniosynostosis treated early

Clinical article

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Object

The authors evaluated the results of complete cognitive function examinations in a series of 65 adolescents who had undergone surgery for sagittal or unicoronal craniosynostosis when they were younger than 1 year old.

Methods

Each of the 65 study participants was evaluated individually. The neuropsychological assessment, consisting of a battery of tests tailored to the patient's age, cognitive level, and level of cooperation, was conducted in 2 separate sessions on the same day. The main outcome measures included fine motor skills, language, visual motor spatial and visual perceptual skills, working and visual memory, attention, executive function, and verbal fluency.

Results

Thirty-five children (mean age 13.4 years) were affected by sagittal synostosis and 30 (mean age 14.9 years) by unicoronal synostosis (16 right-sided, 14 left-sided). The mean age at surgery was 7.2 months. All of the children had begun school at a normal age and attended regular classes. Seven percent of those with sagittal craniosynostosis demonstrated visuospatial and constructional ability defects with associated visual memory recall deficits; 17% also exhibited selective and sustained attention deficits. Approximately one-third (30%) of the children with anterior plagiocephaly had processing and planning speech deficits.

Conclusions

Data in this study support the hypothesis that children with sagittal or unicoronal craniosynostosis, although they undergo early surgical treatment, may still manifest lower than average results at long-term selective neuropsychological evaluations.

Abbreviations used in this paper: ISS = isolated sagittal synostosis; MDI = Mental Development Index; PIQ = Performance IQ; SSC = single-suture craniosynostosis; TIQ = Total IQ; VIQ = Verbal IQ; WISC-R = Wechsler Intelligence Scale for Children–Revised.

Article Information

Address correspondence to: Daniela Chieffo, Ph.D., Department of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Largo “A. Gemelli,” 8, Rome 00168, Italy. email: danielachieffo@iol.it.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph showing age distribution of the patients at the time of the surgical treatment.

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    Bar graph demonstrating the distribution of MDI scores in patients with or without craniosynostosis: high average scores, 130–115 (> 2 SDs); average scores, 115–100 (> 1 SD); low average scores, 100–85 (< 1 SD); low scores, 85–70 (< 2 SDs).

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    Bar graph demonstrating VIQs and PIQs in patients with or without craniosynostosis. Note the significant difference within the intelligence profile.

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    Distribution of neuropsychological disorders in the sagittal craniosynostosis, plagiocephaly, and control groups. VMI = Visual Motor Integration; VMI perc = VMI perceptual.

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    School performance of the participants with documented impairment at neuropsychological evaluations.

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