Chieffo D P R, Arcangeli V, Bianchi F, Salerni A, Massimi L, Frassanito P, Tamburrini G
Institute of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy.
Pediatric Neurosurgery, Institute of Neurosurgery, Fondazione Policlinico Gemelli IRCCS, Catholic University Medical School, Rome, Italy.
Childs Nerv Syst. 2020 Jul;36(7):1481-1488. doi: 10.1007/s00381-020-04521-w. Epub 2020 Feb 1.
In spite of literature data stating that children with single-suture craniosynostosis have an increased risk for neuropsychological deficits, no data are present clarifying the potential risk factors.
All children with non-syndromic single-suture craniosynostosis operated on from January 2014 to January 2017 were enrolled. A comprehensive neurocognitive and neuro-ophthalmological evaluation was performed before surgery and 6 months after surgery. A further neurocognitive evaluation was performed 12 months after surgery. All children had a preoperative CT/MR study.
One hundred forty-two patients were enrolled; 87 are affected by sagittal craniosynostosis, 38 by trigonocephaly, and 17 by plagiocephaly. A global neurocognitive impairment was documented in 22/87 children with scaphocephaly, 5/38 children with trigonocephaly, and 6/17 children with anterior plagiocephaly. There was a significant relationship between results of the ophthalmological evaluation, global IQ, and CT findings at diagnosis (r = 0.296, p < 0.001; r =0.187, p 0.05). Though a significant recovery was documented after surgery, a persistence of eye coordination deficits was present at 6 months in 1 out of 3 children with abnormal preoperative exams. A significant correlation was found between pathological CT findings and persistence of below average neuro-ophthalmological and neurocognitive findings 6 months after surgery, as well as between CT findings and neurocognitive scores at the 1 year follow-up (r = 0.411; p < 0.01).
The presence of neuroradiological abnormalities appears to be related to both ophthalmological and neurocognitive deficits at diagnosis. This relationship is maintained in spite of the surgical treatment in children who show the persistence of ophthalmological and neurocognitive deficits during the follow-up.
尽管文献资料表明，患有单缝颅缝早闭的儿童出现神经心理缺陷的风险增加，但尚无数据阐明潜在的风险因素。
纳入2014年1月至2017年1月接受手术治疗的所有非综合征性单缝颅缝早闭患儿。在手术前和手术后6个月进行了全面的神经认知和神经眼科评估。术后12个月进行了进一步的神经认知评估。所有患儿均进行了术前CT/MR检查。
共纳入142例患者；87例为矢状缝颅缝早闭，38例为三角头畸形，17例为斜头畸形。在22/87例舟状头畸形患儿、5/38例三角头畸形患儿和6/17例前斜头畸形患儿中记录到整体神经认知障碍。眼科评估结果、整体智商与诊断时的CT表现之间存在显著相关性（r = 0.296，p < 0.001；r = 0.187，p < 0.05）。尽管手术后有显著恢复，但术前检查异常的3例患儿中，有1例在术后6个月仍存在眼协调功能障碍。术后6个月，病理CT表现与神经眼科和神经认知检查结果低于平均水平的持续存在之间存在显著相关性，以及CT表现与1年随访时的神经认知评分之间存在显著相关性（r = 0.411；p < 0.01）。
神经放射学异常的存在似乎与诊断时的眼科和神经认知缺陷均相关。尽管对随访期间仍存在眼科和神经认知缺陷的患儿进行了手术治疗，但这种关系仍然存在。
