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The Effects of Whole-Vault Cranioplasty versus Strip Craniectomy on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis

Hashim, Peter W. B.A.; Patel, Anup M.D., M.B.A.; Yang, Jenny F. B.S.; Travieso, Roberto M.D.; Terner, Jordan M.D.; Losee, Joseph E. M.D.; Pollack, Ian M.D.; Jane, John Sr. M.D., Ph.D.; Jane, John Jr. M.D.; Kanev, Paul M.D.; Mayes, Linda M.D.; Duncan, Charles M.D.; Bridgett, David J. Ph.D.; Persing, John A. M.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 491–501
doi: 10.1097/PRS.0000000000000420
Pediatric/Craniofacial: Original Articles
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Discussion

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.

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.

Received for publication September 23, 2013; accepted January 27, 2014.

The first two authors contributed equally to this work.

Presented at the 15th Biennial Congress of the International Society of Craniofacial Surgery, in Jackson, Wyoming, September 10 through 14, 2013.

Disclosures: The authors have no financial interest to declare in relation to the content of this article.

John A. Persing, M.D., Yale Plastic and Reconstructive Surgery, 330 Cedar Street, Third Floor, New Haven, Conn. 06520, john.persing@yale.edu

©2014American Society of Plastic Surgeons