From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine.
Plast Reconstr Surg. 2020 May;145(5):1241-1248. doi: 10.1097/PRS.0000000000006746.
Reports of neurodevelopmental delays in adolescents with metopic craniosynostosis have ranged from 15 to 61 percent. Previously, event-related potentials have correlated preoperative radiographic severity with language deficiencies in infancy. This study sought to characterize neurocognitive testing at cranial maturity and correlate outcomes to preoperative radiographic severity.
Patients diagnosed with metopic craniosynostosis who underwent surgical correction in infancy completed a neurodevelopmental battery evaluating age-normalized intelligence quotient, academic achievement, and visuomotor integration. Data were stratified by preoperative endocranial bifrontal angle (moderate, >124 degrees; severe, <124 degrees). Multiple variable regression was used to control measured intelligence and achievement for age at surgery, age at testing, parental education, and income. Significance was set at p < 0.05.
Twenty patients completed neurodevelopmental testing. Mean intelligence quotient was 111.7 ± 13 and academic achievement was similar to national averages (word reading, 53.4 percent; reading comprehension, 53.4 percent; reading composite, 53.5 percent; spelling, 44 percent; and math, 52.9 percent). Radiographic measurements revealed 36 percent of patients with moderate phenotype and 64 percent with severe. Patients with severe phenotypes had lower intelligence quotient measures and scored more poorly in every academic measure tested. Word reading (113 versus 95; p = 0.035) and reading composite (109 versus 98; p = 0.014) reached significance.
Overall, cranial mature patients with metopic craniosynostosis had above average intelligence quotient and academic achievement near the national mean. Long-term neurocognitive function was correlated to preoperative radiographic severity in metopic craniosynostosis, with more severe cases performing worse.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
患有额缝早闭的青少年出现神经发育迟缓的报告率在 15%至 61%之间。先前，事件相关电位已将术前放射学严重程度与婴儿期的语言缺陷相关联。本研究旨在描述颅骨成熟时的神经认知测试，并将结果与术前放射学严重程度相关联。
接受过婴儿期手术矫正的额缝早闭患者完成了一项神经发育测试包，评估了年龄标准化智商、学业成绩和视动整合。根据术前颅内腔额角（中度，>124 度；重度，<124 度）对数据进行分层。多元变量回归用于控制手术年龄、测试年龄、父母教育程度和收入等因素对智力和成绩的影响。p 值<0.05 具有统计学意义。
20 名患者完成了神经发育测试。平均智商为 111.7±13，学业成绩与全国平均水平相似（阅读，53.4%；阅读理解，53.4%；阅读综合，53.5%；拼写，44%；数学，52.9%）。放射学测量显示，36%的患者为中度表型，64%的患者为重度表型。严重表型的患者智商较低，在每个测试的学业指标上的得分都较低。阅读（113 与 95；p=0.035）和阅读综合（109 与 98；p=0.014）达到显著差异。
总体而言，患有额缝早闭的成熟颅骨患者智商和学业成绩均高于平均水平，接近全国平均水平。在额缝早闭中，长期神经认知功能与术前放射学严重程度相关，严重程度越重，表现越差。
临床问题/证据水平：风险，II。
