Impact of age at surgery on neurodevelopmental outcomes in sagittal synostosis

Restricted access


The aim of this study was to ascertain whether age at surgery has an impact on later neurodevelopmental outcomes for children with sagittal synostosis (SS).


The developmental outcome data from patients who had surgery for SS and who attended their routine preoperative, 6–7 months postoperative, and 5-year-old developmental assessments (yielding general quotients [GQs]) (n = 50), 10-year-old IQ assessment (n = 54), and 15-year-old IQ assessment (n = 23) were examined, comparing whether they had surgery at < 7 months, 7 to < 12 months, or ≥ 12 months).


There was no significant effect for age at surgery for GQ at 5 years of age, but there was a significant effect (p = 0.0001) for those undergoing surgery at < 7 months in terms of preoperative gross locomotor deficit that resolved by 6–7 months postoperatively (increase of 22.1 points), and had further improved by 5 years of age (total increase of 29.4 points). This effect was lessened when surgery was performed later (total increase of 7.3 points when surgery was performed at ≥ 12 months). At 10 years of age, 1-way ANOVA showed a significant difference in Full Scale IQ (FSIQ) score (p = 0.013), with the highest mean FSIQ being obtained when surgery was performed at < 7 months of age (score 107.0), followed by surgery at 7 to < 12 months (score 94.4), and the lowest when surgery was performed at ≥ 12 months (score 93.6). One-way ANOVA for the Performance IQ (PIQ) was very similar (p = 0.012), with PIQ scores of 101.4, 91.4, and 87.3, respectively. One-way ANOVA for Verbal IQ (VIQ) was again significant (p = 0.05), with VIQ scores of 111.3, 98.9, and 100.4, respectively. At 15 years, 1-way ANOVA showed a significant difference in PIQ (p = 0.006), with the highest mean PIQ being obtained when surgery was performed at < 7 months (score 104.8), followed by surgery at 7 to < 12 months (score 90.0), and the lowest when surgery was at performed at ≥ 12 months of age (score 85.3). There were no significant results for FSIQ and VIQ, although there was a similar trend for better outcomes with early surgery.


The findings of this study add to the literature that suggests that early surgery for SS may result in improved neurodevelopmental outcomes, with surgery optimally undertaken when patients are < 7 months of age, and with those undergoing surgery at ≥ 12 months performing the least well. These results also have potential implications for ensuring early diagnosis and referral and for the type of surgery offered. Further research is needed to control for confounding factors and to identify the mechanism by which late surgery may be associated with poorer neurodevelopmental outcomes.

ABBREVIATIONS FSIQ = Full Scale IQ; GMDS = Griffiths Mental Development Scales; GQ = general quotient; OP = observed power; PIQ = Performance IQ; SS = sagittal synostosis; VIQ = Verbal IQ; WASI = Wechsler Abbreviated Scale of Intelligence; WISC-IV-UK = Wechsler Intelligence Scale for Children—Fourth United Kingdom Edition.

Article Information

Correspondence Maggie Bellew: Leeds General Infirmary, Leeds, United Kingdom.


INCLUDE WHEN CITING Published online January 18, 2019; DOI: 10.3171/2018.8.PEDS18186.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.




Aldridge KCollett BRWallace ERBirgfeld CAustin JRYeh R: Structural brain differences in school-age children with and without single suture craniosynostosis. J Neurosurg Pediatr 19:4794892017


Aldridge KKane AAMarsh JLYan PGovier DRichtsmeier JT: Relationship of brain and skull in pre- and postoperative sagittal synostosis. J Anat 206:3733852005


Arnaud EMeneses PLajeunie EThorne JAMarchac DRenier D: Postoperative mental and morphological outcome for nonsyndromic brachycephaly. Plast Reconstr Surg 110:6132002


Becker DBPetersen JDKane AACradock MMPilgram TKMarsh JL: Speech, cognitive, and behavioral outcomes in nonsyndromic craniosynostosis. Plast Reconstr Surg 116:4004072005


Bellew MChumas P: Long-term developmental follow-up in children with nonsyndromic craniosynostosis. J Neurosurg Pediatr 16:4454512015


Bellew MChumas PMueller RLiddington MRussell J: Pre- and postoperative developmental attainment in sagittal synostosis. Arch Dis Child 90:3463502005


Bellew MLiddington MChumas PRussell J: Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up. J Neurosurg Pediatr 7:1211262011


Bhardwaj MRohtagi M: Post-operative mental development in patients with hydrocephalus and craniosynostosis. Indian Pediatr 31:130113041994


Bottero LLajeunie EArnaud EMarchac DRenier D: Functional outcome after surgery for trigonocephaly. Plast Reconstr Surg 102:9529601998


Cohen SRCho DCNichols SLSimms CCross KPBurstein FD: American society of maxillofacial surgeons outcome study: preoperative and postoperative neurodevelopmental findings in single-suture craniosynostosis. Plast Reconstr Surg 114:8418492004


Di Rocco FKnoll BIArnaud EBlanot SMeyer PCuttarree H: Scaphocephaly correction with retrocoronal and prelambdoid craniotomies (Renier’s “H” technique). Childs Nerv Syst 28:132713322012


Griffiths R: The Abilities of Babies. Amersham, UK: Association for Research in Infant and Child Development1986


Griffiths R: The Abilities of Young Children. Amersham, UK: Association for Research in Infant and Child Development1984


Kapp-Simon KA: Mental development and learning disorders in children with single suture craniosynostosis. Cleft Palate Craniofac J 35:1972031998


Kapp-Simon KASpeltz MLCunningham MLPatel PKTomita T: Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 23:2692812007


Knight SJAnderson VASpencer-Smith MMDa Costa AC: Neurodevelopmental outcomes in infants and children with single-suture craniosynostosis: a systematic review. Dev Neuropsychol 39:1591862014


Magge SNWesterveld MPruzinsky TPersing JA: Long-term neuropsychological effects of sagittal craniosynostosis on child development. J Craniofac Surg 13:991042002


Mandela RBellew MChumas PNash H: Impact of surgery timing for craniosynostosis on neurodevelopmental outcomes: a systematic review. J Neurosurg Pediatr [in press]2019


Mathijssen IM: Guideline for Care of Patients With the Diagnoses of Craniosynostosis: Working Group on Craniosynostosis. J Craniofac Surg 26:173518072015


Mathijssen IArnaud ELajeunie EMarchac DRenier D: Postoperative cognitive outcome for synostotic frontal plagiocephaly. J Neurosurg 105 (1 Suppl):16202006


McLaurin RLMatson DD: Importance of early surgical treatment of craniosynostosis; review of 36 cases treated during the first six months of life. Pediatrics 10:6376521952


Patel AYang JFHashim PWTravieso RTerner JMayes LC: The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis. Plast Reconstr Surg 134:608e617e2014


Shastin DPeacock SGuruswamy VKapetanstrataki MBonthron DTBellew M: A proposal for a new classification of complications in craniosynostosis surgery. J Neurosurg Pediatr 19:6756832017


Shillito J JrMatson DD: Craniosynostosis: a review of 519 surgical patients. Pediatrics 41:8298531968


Speltz MLEndriga MCMouradian WE: Presurgical and postsurgical mental and psychomotor development of infants with sagittal synostosis. Cleft Palate Craniofac J 34:3743791997


Starr JRCollett BRGaither RKapp-Simon KACradock MMCunningham ML: Multicenter study of neurodevelopment in 3-year-old children with and without single-suture craniosynostosis. Arch Pediatr Adolesc Med 166:5365422012


Starr JRKapp-Simon KACloonan YKCollett BRCradock MMBuono L: Presurgical and postsurgical assessment of the neurodevelopment of infants with single-suture craniosynostosis: comparison with controls. J Neurosurg 107 (2 Suppl):1031102007


Wechsler D: Wechsler Intelligence Scale for Children–Fourth UK Edition (WISC-IV UK). London: Pearson Assessment2004


Wechsler D: Wechsler Abbreviated Scale of Intelligence (WASI). San Antonio: Harcourt Assessment1999


Wechsler D: WISC-IV: Wechsler Intelligence Scale for Children Integrated: Technical and Interpretive Manual. San Antonio: Harcourt Brace & Company2004




All Time Past Year Past 30 Days
Abstract Views 119 119 75
Full Text Views 61 61 53
PDF Downloads 40 40 35
EPUB Downloads 0 0 0


Google Scholar