Introduction: This pilot study seeks to compare the long-term neurocognitive outcomes of two pediatric cohorts treated for sagittal synostosis using spring-assisted surgery (SAS) or cranial vault remodeling (CVR)
Methods: Patients previously treated for sagittal synostosis at < 6 months of age were recruited from Wake Forest or Yale Universities, having undergone SAS or CVR, respectively. Cognitive tests administered included an abbreviated measure of intelligence (IQ), academic achievement, and visual-motor integration. Key demographic variables collected included gender, race, age at surgery, birth weight, family income, parental age and parental education. Analysis of covariance (ANCOVA) models were used to compare cohorts controlled for these variables. To the extent possible, interrater reliability between several test administrators was conducted and available IQ data was audited.
Results: The final sample included 39 SAS and 36 CVR patients. Mean age at surgery for the SAS and CVR cohorts were 4.7 and 4.8 months (p=0.82). Mean age at testing for the SAS and CVR cohorts was significantly different (11.4 vs. 9.0 yrs; p=0.001). No significant differences were found with respect to gender, race, birth weight, family income, or parental education. The CVR cohort had significantly older paternal (39.6 vs. 31.0 yrs, p<0.001) and maternal (35.4 vs. 29.0 yrs, p<0.001) ages. The CVR cohort had significantly higher verbal IQ (118 vs. 103, p<0.001), performance IQ (110 vs. 100, p=0.022), and full-scale IQ (116 vs. 102, p<0.001). When restricting patient IQ from 80–120, the CVR cohort had significantly higher verbal (p=0.012) and full-scale (p=0.023) IQs, but not performance IQ (p=0.22). No significant differences between groups were identified in academic achievement. The CVR cohort had significantly higher visual-motor integration scores than the SAS group (110 vs. 99, p=0.002).
Conclusion: This study identified significantly increased IQ and VMI scores among patients with sagittal synostosis treated with CVR compared to SAS. There were no academic achievement performance differences between groups. Mean IQ scores among the SAS cohort as a group were within age expectations. Limitations of the study include potential confounding variables such as selection or geographic bias and reduced sample size with the full covariate analyses. This represents the first comparison of long-term neurocognitive outcomes between SAS and CVR for sagittal synostosis. Further studies are warranted to identify factors that may contribute to cognitive outcome differences between surgical interventions.