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Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
Radiographic Severity of Metopic Craniosynostosis Correlates with Long-Term Neurocognitive Outcomes
Kyle S Gabrick1, Robin T Wu1, Anusha Singh1
1From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale School of Medicine.
Insights
Adolescents with metopic craniosynostosis generally show normal intelligence and academic achievement. However, more severe cases of metopic craniosynostosis are linked to poorer neurocognitive outcomes.
Area of Science:
- Pediatric Neurosurgery
- Neurodevelopmental Pediatrics
- Craniofacial Surgery
Background:
- Metopic craniosynostosis is associated with a wide range of neurodevelopmental delays in adolescents (15-61%).
- Previous research linked early radiographic severity to infant language deficits.
- This study investigates long-term neurocognitive function in relation to early metopic craniosynostosis severity.
Purpose of the Study:
- To assess neurocognitive outcomes in individuals with metopic craniosynostosis at cranial maturity.
- To correlate these outcomes with preoperative radiographic severity.
Main Methods:
- Twenty patients with surgically corrected metopic craniosynostosis completed neurodevelopmental testing.
- Evaluations included intelligence quotient, academic achievement, and visuomotor integration.
- Data were analyzed based on preoperative severity (moderate vs. severe) using regression analysis.
Main Results:
- Mean intelligence quotient was above average (111.7 ± 13).
- Academic achievement was near national averages.
- Severe metopic craniosynostosis phenotypes showed significantly lower intelligence quotient and poorer academic performance, particularly in word reading and reading composite scores.
Conclusions:
- Individuals with metopic craniosynostosis typically achieve above-average intelligence and near-average academic performance by cranial maturity.
- Long-term neurocognitive function is significantly correlated with the preoperative radiographic severity of metopic craniosynostosis.
- More severe presentations are associated with worse neurocognitive outcomes.
Background:
Reports of neurodevelopmental delays in adolescents with metopic craniosynostosis have ranged from 15 to 61 percent. Previously, event-related potentials have correlated preoperative radiographic severity with language deficiencies in infancy. This study sought to characterize neurocognitive testing at cranial maturity and correlate outcomes to preoperative radiographic severity.
Methods:
Patients diagnosed with metopic craniosynostosis who underwent surgical correction in infancy completed a neurodevelopmental battery evaluating age-normalized intelligence quotient, academic achievement, and visuomotor integration. Data were stratified by preoperative endocranial bifrontal angle (moderate, >124 degrees; severe, <124 degrees). Multiple variable regression was used to control measured intelligence and achievement for age at surgery, age at testing, parental education, and income. Significance was set at p < 0.05.
Results:
Twenty patients completed neurodevelopmental testing. Mean intelligence quotient was 111.7 ± 13 and academic achievement was similar to national averages (word reading, 53.4 percent; reading comprehension, 53.4 percent; reading composite, 53.5 percent; spelling, 44 percent; and math, 52.9 percent). Radiographic measurements revealed 36 percent of patients with moderate phenotype and 64 percent with severe. Patients with severe phenotypes had lower intelligence quotient measures and scored more poorly in every academic measure tested. Word reading (113 versus 95; p = 0.035) and reading composite (109 versus 98; p = 0.014) reached significance.
Conclusions:
Overall, cranial mature patients with metopic craniosynostosis had above average intelligence quotient and academic achievement near the national mean. Long-term neurocognitive function was correlated to preoperative radiographic severity in metopic craniosynostosis, with more severe cases performing worse.
Clinical Question/Level Of Evidence:
Risk, II.
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