Radiographic severity is associated with worse executive function in metopic craniosynostosis.

Area of Science:

• Pediatric Neurosurgery
• Developmental Neuroscience
• Craniofacial Surgery

Background:

• Metopic synostosis is associated with increased neurocognitive and behavioral difficulties in children.
• The impact of morphologic severity on neurodevelopmental outcomes requires further investigation.
• This study examines factors influencing neurodevelopmental outcomes in children with metopic synostosis.

Purpose of the Study:

• To assess factors, including morphologic severity and age at surgery, associated with neurocognitive and behavioral outcomes in children with metopic synostosis.
• To identify predictors of worse school-age outcomes in this population.

Main Methods:

• Neurocognitive testing and parent-completed behavior rating surveys (Conners-3, SRS-2, BRIEF-2, CBCL) were administered to children aged 6-18 with surgically corrected metopic synostosis.
• Pre-operative CT scans were analyzed to determine metopic synostosis severity using measurements like frontal angle (FA) and AI-derived metopic severity score (MSS).
• Multivariate linear regressions evaluated associations between age at surgery, severity metrics, and neurodevelopmental outcomes.

Main Results:

• Greater phenotypic severity of metopic synostosis correlated with poorer executive function (BRIEF-2) and ADHD-related executive deficits (Conners-3).
• Later age at surgery (over 12 months) was associated with worse executive function scores on the Conners-3, independent of severity.
• A majority of children with metopic synostosis exhibited signs of ADHD.

Conclusions:

• Increased phenotypic severity of metopic synostosis is linked to impaired executive function in school-aged children.
• Later surgical intervention may negatively impact executive functioning, irrespective of metopic synostosis severity.
• Future research should focus on elucidating the direct structural brain changes associated with metopic synostosis.