S8A-07 SESSION 8A: METOPIC SYNOSTOSIS TRIGONOCEPHALY, A SHIFT IN INDICATION FOR SURGERY

Abstract

Introduction: Patients with metopic synostosis have a very small chance to develop raised intracranial pressure. In addition, there is no conclusive evidence yet that a surgical correction of trigonocephaly will improve neurocognitive outcome. Only for the most severe presentations of trigonocephaly, there is clear gain in aesthetic outcome. Therefore, the indication for surgery for metopic synostosis at our center shifted towards correction of only the severe clinical presentations in the past three years. The objective is to study the differences between the operated and non-operated group of trigonocephaly patients at our center. Methods: All patients referred to our center for trigonocephaly in the past three years were evaluated. In this presentation, physical parameters on which the operation indication was based are analysed, using photographs, CT and fundoscopy. Furthermore, the results of both the operated and non-operated trigonocephaly patients on the Bayley Scales of Infant and Toddler Development (a developmental test including a Cognitive, Language, and Motor Scale), taken around the age of two years, will be presented. Results: 218 patients were initially referred to our center for trigonocephaly in the period 2016–2018. Further follow-up after the first visit was not indicated in 128 patients (very mild presentation/ metopic ridge). Of the remaining 90 patients, at the first visit, 39 patients had an indication for follow-up without surgery (fundoscopy/ head circumference), and 26 patients got the indication for a fronto-orbital advancement, which they all received. Twenty-five patients had a reassessment at the age of 9 months; a natural improvement occurred in 20 patients, 3 patients were operated and 2 patients had an operation indication but surgery was refused by the parents. The most important clinical parameter for indication for surgery was the relation between the lateral parts of the forehead and the lateral orbital rims from bird eyes view. Fifteen patients of the operated group and 15 patients of the non-operated group received the developmental test. Conclusion: Natural improvement was observed, which advocates reassessment in a selected group. Short-term neurocognitive evaluation can be indicative for the future, but further longitudinal follow-up is necessary to determine whether there is a neurocognitive indication for operation or whether it is just an aesthetic procedure. This knowledge is important, in order to better involve parents in the shared decision making process of this possible high risk procedure.