title: The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis.
abstract: BACKGROUND
  The optimal type of surgical management for isolated sagittal synostosis remains a source of significant debate. There is a paucity of data regarding possible differences in long-term neuropsychological outcomes following treatment with whole-vault cranioplasty or endoscopic strip craniectomy. This study provides the first comparative analysis examining the effects of the two techniques related to long-term intellectual functioning.
  
  
  METHODS
  A total of 70 patients were enrolled in this multicenter study, 29 of whom had previously undergone endoscopic strip craniectomy and 41 of whom had previously undergone whole-vault cranioplasty. All patients completed a battery of neurodevelopmental tests (Beery-Buktenica Developmental Test of Visual-Motor Integration, Wechsler Abbreviated Scale of Intelligence, and Wechsler Fundamentals) to evaluate various domains of neuropsychological function.
  
  
  RESULTS
  In a group comparison of those treated before 6 months of age, whole-vault patients obtained higher scores relative to endoscopic strip craniectomy patients on visuomotor integration, full-scale intelligence quotient, verbal intelligence quotient, word reading, and reading comprehension (p < 0.05 for all). When compared against strip craniectomy performed before 3 months of age, the whole-vault group still showed significantly higher scores in verbal intelligence quotient, reading comprehension, and word reading (p < 0.05 for all).
  
  
  CONCLUSIONS
  The type of surgical intervention for isolated sagittal synostosis impacts long-term neuropsychological outcomes. Patients undergoing early whole-vault cranioplasty attained higher intelligence quotient and achievement scores relative to those undergoing strip craniectomy. Surgical management with whole-vault cranioplasty performed before 6 months of age provides the most favorable long-term intellectual outcomes in patients with isolated sagittal synostosis.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: New Haven and Hartford, Conn.; Pittsburgh, Pa.; Charlottesville, Va.; and DeKalb, Ill. From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine; the University of Pittsburgh School of Medicine; the Department of Neurosurgery, University of Virginia School of Medicine; the Craniofacial Surgery Center, Connecticut Children's Medical Center; and the Department of Psychology, Northern Illinois University.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hashim
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
authors.forename: Jenny F
authors.initials: JF
authors.lastname: Yang
authors.forename: Roberto
authors.initials: R
authors.lastname: Travieso
authors.forename: Jordan
authors.initials: J
authors.lastname: Terner
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.forename: Ian
authors.initials: I
authors.lastname: Pollack
authors.forename: John
authors.initials: J
authors.lastname: Jane
authors.forename: John
authors.initials: J
authors.lastname: Jane
authors.forename: Paul
authors.initials: P
authors.lastname: Kanev
authors.forename: Linda
authors.initials: L
authors.lastname: Mayes
authors.forename: Charles
authors.initials: C
authors.lastname: Duncan
authors.forename: David J
authors.initials: DJ
authors.lastname: Bridgett
authors.forename: John A
authors.initials: JA
authors.lastname: Persing
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000523:psychology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods* / Q000523:psychology; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008607:Intellectual Disability / Q000175:diagnosis / Q000209:etiology*; D007361:Intelligence Tests; D007859:Learning Disabilities / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D044583:Neuroendoscopy; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000523:psychology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult