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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.

Clinical Neurology and Neurosurgery
|June 28, 2021
PubMed
Summary

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.

Keywords:
Cranial expansionFunctional developmentMicrocephalyOutcomeSocial emotional status

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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.