S7A-19 SESSION 7A: SAGITTAL SYNOSTOSIS LONG-TERM NEUROCOGNITIVE OUTCOMES IN SAGITTAL SYNOSTOSIS: THE IMPACT OF REOPERATION

Abstract

Introduction: Optimal age at surgery in nonsyndromic sagittal craniosynostosis (NSC) continues to be debated. This study examined the impact of reoperation on neurocognitive outcome in children with NSC using comprehensive neurocognitive testing. Methods: Forty-seven school-age children (age 5–16 years) with NSC who underwent whole-vault cranioplasty were included in this analysis. Twenty-four participants underwent early surgery (operated at age 6 months or younger; mean age at surgery 4.8 months), and 23 participants underwent later surgery (operated at age greater than 6 months; mean age at surgery 14.3 months). Participants were administered a battery of standardized neuropsychological testing (Wechsler Abbreviated Scale of Intelligence, Wechsler Fundamentals, Beery-Buktenica Visual Motor Integration) to measure neurocognitive outcomes. Results: Thirteen out of the 47 participants underwent a reoperation (27.7%); 11 out of the 13 reoperations were minor revisions while 2 reoperations were cranioplasties. Of the two participants who underwent major revisions, one was in the early surgery and the other was in the late surgery group. Reoperation rate was not statistically greater in those patients who had early surgery when compared to late surgery. Later surgery patients did not perform statistically better than early first surgery patients, even when the early surgery patients underwent reoperation, on any outcome measure of neurocognitive function, including IQ, academic achievement, visuomotor integration, executive function, and behavior (p>0.05 for all). Comparing reoperated early surgery patients with non-reoperated late surgery patients, reoperated early surgery patients scored significantly higher on word reading, reading comprehension, spelling, numerical operations, and visuomotor integration (p<0.05), and had fewer indicators of suspected learning disabilities compared to non-reoperated late surgery patients. Conclusion: Reoperation rate after whole vault cranioplasty was observed to be 27.7%, with few cases of repeat cranioplasty (4.3% of all patients). Operated and reoperated early surgery patients performed better in IQ, academic achievement, and visuomotor integration compared with non-reoperated late surgery patients. This provides evidence that whole-vault cranioplasty before 6 months of age is associated with better neurocognitive outcome compared to after 6 months of age, even when early surgery requires a reoperation.