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Lacunar skull deformity related to intelligence in children with myelomeningocele and hydrocephalus
Insights
Lacunar skull deformity in infants with myelomeningocele and hydrocephalus does not reliably predict lower intelligence. Most children with severe deformities achieved IQs above 70, questioning its use in treatment selection.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Medical Imaging
Background:
- Lacunar skull deformity has been proposed as an indicator of intellectual disability in infants with myelomeningocele and hydrocephalus.
- This association suggested its potential utility in early treatment selection for affected children.
Purpose of the Study:
- To investigate the relationship between lacunar skull deformity and intellectual outcomes in children with myelomeningocele and hydrocephalus.
- To determine if lacunar skull deformity is a valid criterion for early treatment selection in this patient population.
Main Methods:
- Retrospective analysis of clinical records and skull X-rays from 169 infants diagnosed with myelomeningocele and hydrocephalus.
- Assessment of intellectual function using the Wechsler Intelligence Scale for Children in 131 children aged five years or older.
- Correlation of the degree of lacunar skull deformity with measured IQ scores.
Main Results:
- A high prevalence (97%) of lacunar skull deformity was observed in the study cohort.
- No significant differences in mean IQ were found across varying degrees of lacunar skull deformity severity.
- 82% of children with the most severe lacunar skull deformity had IQs exceeding 70.
Conclusions:
- Lacunar skull deformity is highly prevalent in infants with myelomeningocele and hydrocephalus.
- The presence and severity of lacunar skull deformity do not appear to be strong predictors of intellectual outcome.
- Findings do not support the use of lacunar skull deformity as a primary criterion for selecting treatment in children with myelomeningocele and hydrocephalus.
Abstract:
It has been suggested that the presence of lacunar skull deformity in infants with myelomeningocele and hydrocephalus is indicative of later lowered intelligence and therefore is a useful criterion in early selection for treatment. In the present study, retrospective investigations were made of the clinical records and skull X-rays of 169 surviving children who had been admitted immediately after birth with myelomeningocele and hydrocephalus to the Children's Hospital, Sheffield. Adequate X-rays were available for 131 of the children, of whom 97 per cent exhibited some degree of lacunar skull deformity. At five years of age or older, the 131 children were tested on the Wechsler Intelligence Scale for Children. The differences in mean IQ between the various degrees of severity were not large, and it was found that 82 per cent of children with the most severe degree of lacunar skull deformity had IQs above 70. These findings do not support the use of lacunar skull deformity as an important measure in selection for treatment of children with myelomeningocele and hydrocephalus.