title: Neurodevelopmental and esthetic results in children after surgical correction of metopic suture synostosis: a single institutional experience.
abstract: BACKGROUND
  Metopic suture synostosis leading to trigonocephaly is considered the second most frequent type of craniosynostosis. Besides esthetic results, we present 25 consecutive pediatric cases operated upon metopic suture synostosis with a focus on the child's motor, speech, and neurocognitive development.
  
  
  METHODS
  Twenty-five children (aged 6 to 33 months; median 9.2 months) with trigonocephaly were operated upon between 2002 and 2012 with fronto-orbital advancement including frontal bone cranioplasty and fronto-orbital bandeau remodeling. Neurodevelopmental deficits were evaluated by a standardized questionnaire including gross motor function, manual coordination, speech, and cognitive function performed by independent pediatric/developmental neurologists before surgery and at 6 and 12 months of time interval postoperatively.
  
  
  RESULTS
  Twenty-one (84 %) boys and four (16 %) girls were included in this study. Mean follow-up period was 33 ± 28 months. Outcome analysis for esthetic results showed a high degree of satisfaction by the parents and treating physicians in 23 cases (92 %). Preoperative evaluation revealed neurodevelopmental deficits in 10 children (40 %; six mild, four moderate degree). Twelve children (48 %) were proven to have a normal preoperative neuropediatric development. Mild or moderate developmental restraints were no longer apparent in 6/13, improved but still apparent in 3/13, and stable in 4/13, 6 months after cranial vault reconstruction. At 12 months of follow-up, deficits were no longer present in 9/13 and improved in 4/13. Apart from this cohort, two children were diagnosed with a syndromic form, and one child had a fetal valproate syndrome. In these three children, neurodevelopmental deficits were more pronounced. Neurocognitive progress was obvious, but was comparably slower, and major deficits were still apparent at last follow-up. All children with proven mild/moderate/severe deficits received intensive physiotherapy, logopedic, or neurobehavioral support.
  
  
  CONCLUSIONS
  As shown in a single-center observation, surgical correction of metopic suture synostosis not only refines esthetic appearance but also might improve neurodevelopmental outcome if deficits are apparent, even in syndromic forms of the deformity under additional physiotherapy, logopedic, or neurobehavioral support.
authors: Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
authors: Mathias
authors: M
authors: Kunz
authors: Markus
authors: M
authors: Lehner
authors: Alfred
authors: A
authors: Heger
authors: Lena
authors: L
authors: Armbruster
authors: Heike
authors: H
authors: Weigand
authors: Gerson
authors: G
authors: Mast
authors: Aurelia
authors: A
authors: Peraud
mesh_terms: D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology* / Q000534:rehabilitation; D003398:Craniosynostoses / Q000601:surgery*; D002658:Developmental Disabilities / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology* / Q000534:rehabilitation; D011597:Psychomotor Performance; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000941:ethics*; D012189:Retrospective Studies; D013060:Speech; D011795:Surveys and Questionnaires; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome