Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up
Maggie Bellew1, Mark Liddington, Paul Chumas
1Department of Plastic, Reconstructive, and Hand Surgery, Leeds General Infirmary, Leeds, United Kingdom. maggie.bellew@leedsth.nhs.uk
Insights
Surgical correction for sagittal synostosis (SS) improves developmental attainment, particularly gross motor skills, which is maintained and enhanced by age five. Early intervention is crucial, as delaying surgery may lead to developmental delays.
Area of Science:
- Pediatric Neurosurgery
- Developmental Pediatrics
- Craniofacial Surgery
Background:
- Sagittal synostosis (SS) is a condition affecting skull development in infants.
- Previous studies indicated short-term developmental improvements after surgical correction of SS.
- Long-term developmental outcomes following SS surgical correction require further investigation.
Purpose of the Study:
- To determine if developmental gains observed after surgical correction of sagittal synostosis (SS) are sustained at 5 years of age.
- To compare long-term developmental outcomes in surgically treated versus non-surgically treated children with SS.
Main Methods:
- A cohort of 32 children with SS underwent surgical correction and were assessed preoperatively, at 7 months postoperatively, and at 5 years using the Griffiths Mental Development Scales.
- A control group of 23 children with SS received developmental assessments without surgery.
- Developmental assessments included Gross Locomotor function and General Quotient.
Main Results:
- Children with SS demonstrated improved Gross Locomotor function and overall General Quotient by age 5 following surgical correction, even in cases of severe developmental delay.
- Improvements in Gross Locomotor function and General Quotient were sustained and further enhanced from 7 months to 5 years post-surgery.
- Children with SS who did not undergo surgery showed no developmental improvement and experienced a deterioration in fine motor control.
Conclusions:
- Surgical correction of sagittal synostosis (SS) provides lasting developmental benefits beyond cosmetic improvements.
- Early surgical intervention for SS is associated with sustained and improved developmental attainment.
- Non-surgical management of SS may result in missed opportunities for developmental gains and potential deterioration.
Object:
The object of this study was to clarify whether improved developmental attainment following surgical correction of sagittal synostosis (SS), previously identified at initial postoperative assessment, is maintained at longer-term follow-up at 5 years of age.
Methods:
The study involved 32 children with SS who underwent corrective surgery at a mean (± SD) age of 8.5 ± 7.25 months (range 2.8-39.9 months). All the children were assessed preoperatively, at 7 months postoperatively, and at 5 years of age, using the Griffiths Mental Development Scales. A control group consisted of 23 children with SS who had received developmental assessment on 2 or more occasions without surgical intervention (8 of these children had had follow-up at 5 years of age).
Results:
The data indicated that, prior to surgical correction, children with SS had poorer Gross Locomotor function than other areas of development and that, following surgical intervention, the deficit resolved (even where there was severe developmental delay). The results further showed that improvement in Gross Locomotor function observed at 7 months postoperatively was further improved upon by 5 years of age. The same was true for their overall General Quotient, even in those children exhibiting severe developmental delay. Lesser improvements across time were shown for other skill areas. The children with SS who did not undergo surgery did not show any improvement in development, and in fact a deterioration in fine locomotor control was identified in these patients.
Conclusions:
The results of this study suggest that corrective surgery for SS has a positive early impact on development, which is maintained and improved upon by 5 years of age, and that this surgery therefore offers more than simply a cosmetic improvement. Furthermore, the results suggest that not operating on children with SS means not only that this opportunity for developmental gain is missed, but that it may also cause an actual deterioration in developmental attainment.
