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[Mental prognosis in scaphocephaly]
Insights
The initial mental development is the key predictor of long-term outcomes in children with scaphocephaly. Early intervention is crucial, as surgery does not significantly improve cognitive function in children with pre-existing developmental delays.
Area of Science:
- Pediatric Neurosurgery
- Developmental Pediatrics
- Cranial Surgery
Context:
- Scaphocephaly, a premature fusion of the sagittal suture, presents complex challenges regarding its impact on cognitive development.
- The decision for surgical intervention in scaphocephaly is often debated, balancing functional and aesthetic considerations without definitive evidence.
- Understanding the relationship between intracranial pressure, age at presentation, and neurodevelopmental outcomes is critical for informed clinical management.
Purpose:
- To investigate the correlation between age at presentation, intracranial pressure (ICP), and mental outcomes in children with scaphocephaly.
- To evaluate the influence of surgical intervention on the mental evolution of patients with scaphocephaly.
- To identify predictive factors for neurodevelopmental outcomes in scaphocephaly.
Summary:
- A prospective study of 396 children with scaphocephaly analyzed the relationship between age, ICP, and mental status.
- Most patients exhibited good mental outcomes regardless of surgical intervention.
- Children diagnosed before one year of age showed significantly better outcomes, with higher rates of normal development and lower incidence of elevated ICP.
Impact:
- The initial developmental level is the primary determinant of mental prognosis in scaphocephaly.
- Delayed presentation (after one year of age) is associated with poorer outcomes and higher ICP.
- These findings suggest that surgical indications for scaphocephaly should consider factors beyond aesthetics, particularly when initial cognitive function is compromised.
Background:
The mental prognosis of scaphocephaly remains a controversial issue, and surgery is performed for functional or aesthetical reasons without clear evidence in the literature of which is the most important.
Patients And Methods:
Three hundred and ninety six children with scaphocephaly were prospectively studied to analyse the correlation between age, intracranial pressure (ICP) and mental outcome. Before any treatment, the intracranial pressure was recorded (systematically during the first period of the study); the mental level was evaluated at first consultation and after a mean five-year follow-up. The mental evolution was compared whether the child was operated or not.
Results:
The mental outcome of the patients was good in most of the cases whether or not they had been operated. There were significantly more normal patients in the scaphocephalies seen before one year of age at first consultation (P < 0.001) than in those seen after one year of age. There were significantly more abnormally high intracranial pressure cases in the group of patients who were seen later than one year of age (P = 0.0015). There were more retarded patients in the group with increased ICP, but the difference was not significant (P = 0.17). There was no correlations between ICP and final IQ neither in operated nor in non-operated patients. Conversely, a correlation was found between the early and late psychometric assessments in all patients.
Conclusions:
The main predictive factor of mental outcome appears to be the initial developmental level. Since the mental level was worse in the older children, and since the surgery does not influence the functional outcome when the initial mental level is low, we can conclude that the indication to perform surgery in scaphocephaly is sometimes not only a cosmetic problem.