From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine; and the Departments of Plastic Surgery and Neurosurgery, Wake Forest School of Medicine.
Plast Reconstr Surg. 2021 Mar 1;147(3):661-671. doi: 10.1097/PRS.0000000000007640.
A long-term neurocognitive comparison of patients with sagittal synostosis who underwent spring-assisted surgery or cranial vault remodeling has not been performed.
Patients with sagittal synostosis who underwent spring-assisted surgery or cranial vault remodeling were recruited from Wake Forest School of Medicine and Yale School of Medicine, respectively. Cognitive tests administered included an abbreviated intelligence quotient, academic achievement, and visuomotor integration. An analysis of covariance model compared cohorts controlling for demographic variables.
Thirty-nine spring-assisted surgery and 36 cranial vault remodeling patients were included in the study. No significant differences between cohorts were found with respect to age at surgery, sex, race, birth weight, family income, or parental education. The cranial vault cohort had significantly older parental age (p < 0.001), and mean age at testing for the spring cohort was significantly higher (p = 0.001). After adjusting for covariates, the cranial vault cohort had significantly higher verbal intelligence quotient (116.5 versus 104.3; p = 0.0024), performance intelligence quotient (109.2 versus 101.5; p = 0.041), and full-scale intelligence quotient (114.3 versus 103.2; p = 0.0032). When included patients were limited to intelligence quotients from 80 to 120, the cranial vault cohort maintained higher verbal (108.0 versus 100.4; p = 0.036), performance (104.5 versus 97.7; p = 0.016), and full-scale (107.6 versus 101.5; p = 0.038) intelligence quotients. The cranial vault cohort had higher visuomotor integration scores than the surgery group (111.1 versus 98.1; p < 0.001). There were no significant differences in academic achievement.
Sagittal synostosis patients who underwent cranial vault remodeling had higher intelligence quotient and visuomotor integration scores. There were no differences in academic achievement. Both cohorts had intelligence quotient scores at or above the normal range. Further studies are warranted to identify factors that may contribute to cognitive outcome differences.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
目前尚未对接受弹簧辅助手术或颅盖成形术的矢状缝早闭患者进行长期神经认知比较。
分别从维克森林医学院和耶鲁大学医学院招募接受弹簧辅助手术或颅盖成形术的矢状缝早闭患者。进行的认知测试包括简短智商、学业成绩和视动整合。使用协方差分析模型，通过控制人口统计学变量对队列进行比较。
该研究纳入了 39 例弹簧辅助手术组和 36 例颅盖成形术组患者。两组在手术时的年龄、性别、种族、出生体重、家庭收入或父母教育程度方面无显著差异。颅盖组的父母年龄明显较大（p < 0.001），而弹簧组的平均测试年龄明显较高（p = 0.001）。在调整协变量后，颅盖组的言语智商明显较高（116.5 比 104.3；p = 0.0024）、表现智商明显较高（109.2 比 101.5；p = 0.041）和全智商明显较高（114.3 比 103.2；p = 0.0032）。当将纳入的患者限制在智商为 80 至 120 之间时，颅盖组的言语智商（108.0 比 100.4；p = 0.036）、表现智商（104.5 比 97.7；p = 0.016）和全智商（107.6 比 101.5；p = 0.038）仍较高。颅盖组的视动整合评分明显高于手术组（111.1 比 98.1；p < 0.001）。学业成绩无显著差异。
接受颅盖成形术的矢状缝早闭患者的智商和视动整合评分较高。学业成绩无差异。两个队列的智商得分均在正常范围内。需要进一步的研究来确定可能导致认知结果差异的因素。
临床问题/证据水平：治疗性，II 级。
