The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis.

Plast Reconstr Surg

New Haven and Hartford, Conn.; Pittsburgh, Pa.; Charlottesville, Va.; and DeKalb, Ill. From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine; the University of Pittsburgh School of Medicine; the Department of Neurosurgery, University of Virginia School of Medicine; the Craniofacial Surgery Center, Connecticut Children's Medical Center; and the Department of Psychology, Northern Illinois University.

Published: September 2014

AI Article Synopsis

  • The study compares long-term intellectual outcomes of two surgical methods for treating isolated sagittal synostosis: whole-vault cranioplasty and endoscopic strip craniectomy.
  • Patients who underwent whole-vault cranioplasty before 6 months of age scored higher in various neuropsychological tests than those treated with endoscopic strip craniectomy.
  • The findings suggest that whole-vault cranioplasty is the more effective surgical option for improving long-term neuropsychological function in young patients with this condition.

Article Abstract

Background: The optimal type of surgical management for isolated sagittal synostosis remains a source of significant debate. There is a paucity of data regarding possible differences in long-term neuropsychological outcomes following treatment with whole-vault cranioplasty or endoscopic strip craniectomy. This study provides the first comparative analysis examining the effects of the two techniques related to long-term intellectual functioning.

Methods: A total of 70 patients were enrolled in this multicenter study, 29 of whom had previously undergone endoscopic strip craniectomy and 41 of whom had previously undergone whole-vault cranioplasty. All patients completed a battery of neurodevelopmental tests (Beery-Buktenica Developmental Test of Visual-Motor Integration, Wechsler Abbreviated Scale of Intelligence, and Wechsler Fundamentals) to evaluate various domains of neuropsychological function.

Results: In a group comparison of those treated before 6 months of age, whole-vault patients obtained higher scores relative to endoscopic strip craniectomy patients on visuomotor integration, full-scale intelligence quotient, verbal intelligence quotient, word reading, and reading comprehension (p < 0.05 for all). When compared against strip craniectomy performed before 3 months of age, the whole-vault group still showed significantly higher scores in verbal intelligence quotient, reading comprehension, and word reading (p < 0.05 for all).

Conclusions: The type of surgical intervention for isolated sagittal synostosis impacts long-term neuropsychological outcomes. Patients undergoing early whole-vault cranioplasty attained higher intelligence quotient and achievement scores relative to those undergoing strip craniectomy. Surgical management with whole-vault cranioplasty performed before 6 months of age provides the most favorable long-term intellectual outcomes in patients with isolated sagittal synostosis.

Clinical Question/level Of Evidence: Therapeutic, II.

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Source
http://dx.doi.org/10.1097/PRS.0000000000000420DOI Listing

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