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Published on: February 2, 2015
Whether cranial expansion is indicated in selected cases with microcephaly?
Yanyan Wang1, Min Wei1, Qijia Zhan1
1Department of Paediatric Neurosurgery, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Luding Rd. 355, Shanghai, China.
Insights
Cranial expansion surgery can improve social-emotional deficits and functional development in young children with microcephaly. This procedure showed significant benefits in social-emotional status and motor, speech, and cognitive functions.
Area of Science:
- Pediatric Neurosurgery
- Developmental Pediatrics
- Craniofacial Surgery
Background:
- Microcephaly in young children (1-2 years) is often associated with severe social-emotional deficits.
- Cranial expansion surgery is not typically considered for these cases.
- The potential benefits of cranial expansion for social-emotional and functional development in microcephaly remain largely unexplored.
Purpose of the Study:
- To evaluate the effectiveness of cranial expansion surgery in improving social-emotional status in children with microcephaly.
- To assess the impact of cranial expansion on the overall functional development of these patients.
- To determine if cranial expansion can be a viable option for selected microcephalic cases with social-emotional deficits.
Main Methods:
- Retrospective cohort review of microcephalic patients who underwent cranial expansion at Shanghai Children's Hospital (June 2016 - June 2017).
- Inclusion and exclusion criteria were applied for patient selection, requiring at least 12 months of follow-up.
- Social-emotional status was assessed using The Infant-Toddler Social and Emotional Assessment (ITSEA), and functional development was evaluated via a neurodevelopmental questionnaire, comparing pre-operative and 12-month post-operative data.
Main Results:
- Fourteen microcephalic cases were included. Post-surgery, head circumference (HC) increased by an average of 0.5 cm within one year.
- At 12 months post-operation, 78.6% of patients showed improvement in all four ITSEA domains, with significant improvements in internalizing and dysregulation behaviors (p < 0.01) and externalizing behaviors and social-emotional competence (p < 0.05).
- Functional development showed improvement in motor, speech, and cognitive functions in 57.1% of cases, with partial improvement in 35.7%. No surgery-related complications were reported.
Conclusions:
- Cranial expansion surgery can be beneficial for microcephalic children aged 1-2 years experiencing social-emotional deficits.
- The procedure demonstrated positive impacts on both social-emotional status and functional development (motor, speech, cognitive).
- This surgical approach may be considered for selected microcephalic cases presenting with progressive copper-beaten signs on skull X-rays.
Purpose:
Some children with microcephaly experienced severe social emotional deficits during their 1-2 years of age. Cranial expansion is generally not used in these cases. Our aim is to assess whether such operation is effective to improve their social emotional status, and thereby boosting their functional development in selected cases with such condition.
Methods:
A retrospective cohort review in microcephalic cases who had undergone cranial expansion in Shanghai Children's Hospital since Jun. 2016 to Jun. 2017 with at least 12 months follow-up was conducted. Inclusion and exclusion criteria were set for the selection of the target patients in the current study. Our study focused on the changes of social emotional status (evaluated by The Infant-Toddler Social and Emotional Assessment, ITSEA) and functional development (applying neurodevelopmental questionnaire) pre- and 12 months post-op in these cases.
Results:
A total of 14 cases were included in the current study. On the basis of a 2-cm enlargement during surgery(1 cm advancement of fronto-orbital rim on each side), HC continued to increase at an average of 0.5 cm in one year after the procedure in these cases, making its corresponding standard deviation improve from -4.5 to -3.4. Among those 14 cases, 11 (78.6%) showed improvement in all of these four domains in ITSEA at 12 months post-op. Scores were significantly better at 12 months post-op with p < 0.01 compared with those in domains of internalizing behavior and dysregulation behavior pre-operatively. Improvement was observed with p < 0.05 in domains of externalizing behavior and social-emotional competence as well. With regard to functional development, 8 cases (57.1%) were revealed improvement in all of these three sections of motor, speech and cognitive function in the questionnaire, 5 (35.7%) concluded partially upgraded in 1 or 2 sections. Only one (7.1%) showed no change during the follow-up. No surgery-related complications were recorded in the current study.
Conclusion:
When progressive copper-beaten sign is revealed in their serial skull X-rays, microcephalic cases with social emotional deficits in their 1-2 years of age could benefit from cranial expansion surgery with regard to improving their social emotional status and functional development.
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