Section of Plastic Surgery, Yale University School of Medicine.
Child Study Center, Yale University School of Medicine.
J Craniofac Surg. 2021;32(1):58-61. doi: 10.1097/SCS.0000000000006909.
Optimal age at surgery in nonsyndromic sagittal craniosynostosis continues to be debated. Previous reports suggest that earlier age at whole vault cranioplasty more frequently requires reoperation. It is unknown, however, whether reoperation affects neurocognitive outcome. This study examined the impact of reoperation on neurocognitive outcome in children with nonsyndromic sagittal craniosynostosis using comprehensive neurocognitive testing.
Forty-seven school-age children (age 5-16 years) with nonsyndromic sagittal craniosynostosis who underwent whole-vault cranioplasty were included in this analysis. Participants were administered a battery of standardized neuropsychological testing to measure neurocognitive outcomes.
Thirteen of the 47 participants underwent reoperation (27.7%); 11 out of the 13 reoperations were minor revisions while 2 reoperations were cranioplasties. Reoperation rate was not statistically different between patients who had earlier surgery (at age ≤6 months) versus later surgery (at age >6 months) (P > 0.05). Nonreoperated patients who had only one later-in-life surgery did not perform statistically better than reoperated patients on any outcome measure of neurocognitive function, including IQ, academic achievement, visuomotor integration, executive function, and behavior. Comparing reoperated earlier surgery patients with nonreoperated later surgery patients, reoperated earlier surgery patients had higher full-scale and verbal IQ (P < 0.05), scored higher on word reading, reading comprehension, spelling, numerical operations, and visuomotor integration (P < 0.05), and had fewer indicators of suspected learning disabilities (P < 0.01) compared to nonreoperated later surgery patients.
Reoperation rate after whole vault cranioplasty was 27.7%, with few cases of repeat cranioplasty (4.2% of all patients). Reoperation was not associated with worse neurocognitive outcome. Reoperated earlier surgery patients in fact performed better in IQ, academic achievement and visuomotor integration when compared to nonreoperated later surgery patients.
在非综合征性矢状缝早闭中，手术的最佳年龄仍存在争议。先前的报告表明，更早行颅盖成形术更频繁地需要再次手术。然而，尚不清楚再次手术是否会影响神经认知结局。本研究使用全面的神经认知测试，检查了非综合征性矢状缝早闭儿童再次手术后对神经认知结局的影响。
本分析纳入了 47 名患有非综合征性矢状缝早闭的学龄儿童（5-16 岁），他们均接受了全颅盖成形术。参与者接受了一系列标准化神经心理测试，以测量神经认知结果。
47 名参与者中有 13 名（27.7%）接受了再次手术；其中 11 次为小的修正手术，2 次为颅盖成形术。在手术年龄≤6 个月的患者和手术年龄>6 个月的患者之间，再次手术的发生率无统计学差异（P>0.05）。仅在后期接受过一次手术的非再手术患者，在任何神经认知功能的结果测量上，包括智商、学业成绩、视动整合、执行功能和行为，均未表现出优于再手术患者的统计学差异。与非再手术后期手术患者相比，再手术早期手术患者的全量表智商和言语智商更高（P<0.05），在单词阅读、阅读理解、拼写、数值运算和视动整合方面得分更高（P<0.05），并且具有较少的疑似学习障碍指标（P<0.01）。
全颅盖成形术后的再手术率为 27.7%，重复颅盖成形术的病例较少（占所有患者的 4.2%）。再次手术与神经认知结局较差无关。与非再手术后期手术患者相比，再手术早期手术患者的智商、学业成绩和视动整合表现更好。
