Date of Award

11-16-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

John Persing

Second Advisor

John Geibel

Abstract

The functional morbidity in nonsyndromic craniosynostosis is not obvious. Because of this disconnect between cranial deformity and functional disability, cranial reconstructive surgery in patients with single-suture sagittal craniosynostosis has been regarded as a cosmetic intervention. However, it has been observed in a preliminary study that children with simple craniosynostosis often have a higher proportion of learning disabilities and cognitive problems as compared to nonafflicted children. The influence of modern comprehensive surgical treatment including the optimal age to perform surgery has not been well-documented. This study examined long-term neuropsychological outcomes of children and adolescents with isolated sagittal craniosynostosis undergoing either limited-strip craniectomy or whole-vault cranioplasty. Furthermore, it assessed if a relationship between the age of surgery on children with isolated sagittal craniosynostosis and neuropsychological effects exists. It is hypothesized those children with isolated sagittal craniosynostosis will have a lower incidence of neuropsychological abnormalities, albeit at a higher incidence than the general population, the earlier in age they undergo the more comprehensive surgical whole-vault cranioplasty. If this study can confirm this hypothesis, then whole-vault cranioplasty at an early age may reduce the long-term neuropsychological effects of children with isolated craniosynostosis. Retrospective inspection of the Yale-New Haven Hospital medical records from 1987 to 2002 identified eleven patients who underwent whole-vault cranioplasty and four patients who underwent limited-strip craniectomy. In terms of surgical age, eight patients underwent surgery younger than six months and seven patients who underwent surgery older than six months. The small sample size of patients in the limited strip-craniectomy group circumvented comparisons between the types of surgery. The study demonstrated that patients undergoing surgery prior to six months of age had improved general cognitive function, academic achievement, executive functioning, and behavior compared to patients undergoing surgery after six months of age. These preliminary findings illustrate that the age of surgery impacts long-term neuropsychological outcomes with further studies necessary to explore the consequences of the type of surgery and specific-suture involvement in craniosynostosis.

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