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Neurocognitive Outcomes In Postoperative Craniosynostosis Patients
Adam H. Junn, BS, Aaron S. Long, BS, Sacha Hauc, BS, BA, MPH, Jean Carlo Rivera, BS, Alexandra Junn, AB, Michael Alperovich, MD, MSc.
Yale Medicine, New Haven, CT, USA.

Neurocognitive Outcomes in Postoperative Craniosynostosis Patients
Purpose: Craniosynostosis has been associated with a variety of neurocognitive deficits. This is the largest cohort of postoperative craniosynostosis patients to undergo formal neurocognitive testing at school age.
Methods: Patients diagnosed with sagittal, metopic, and coronal synostosis completed age-normalized intelligence quotient (IQ) and visuomotor skills tests between 2016 2021. Associations between synostosis sub-type and IQ, VMI scores, age at surgery, age at testing, sex, race, breastfeeding, premature birth, and maternal and paternal education were evaluated using ANOVA for continuous variables and chi-square tests for categorical variables.
Results: 203 patients completed neurocognitive testing (141 sagittal, 36 metopic, 22 coronal and 4 lambdoid). 109 (54%) of the cohort was male, and 148 (73%) were White. The mean IQ was 106.08 14.04 and the mean age at surgery and testing was 8.96 12.22 and 181.17 119.27 months respectively. Sagittal craniosynostosis patients had higher scores in every testing category than metopic craniosynostosis patients, with significant differences in verbal IQ (109.35 15.70 vs 100.81 10.38), full-scale IQ (108.31 14.37 vs 99.39 11.88), visuomotor integration (101.55 13.56 vs 92.09 12.15), visual perception (103.57 12.59 vs 96.03 11.22), and motor coordination (90.29 15.51 vs 84.91 16.03). Significant differences were found between patients with sagittal and coronal craniosynostosis in visuomotor integration (101.55 13.56 vs 94.95 10.24) and visual perception (103.57 12.59 vs 94.82 12.75). There were no significant differences between groups in terms of age at surgery, age at testing, parental education level, prematurity, and sex.
Conclusion: Compared to patients with sagittal synostosis, those with metopic synostosis exhibited lower testing scores in verbal IQ, full-scale IQ, visuomotor integration, visual perception, and motor control after surgical correction. This suggests that the frontal constriction due to premature fusion of the metopic suture may have lasting impacts on brain function. Patients with coronal synostosis exhibited lower visuomotor integration and visual perception scores when compared to patients with sagittal synostosis. This suggests that constriction of the brain by premature fusion of the coronal suture may have an effect on visual information processing.


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