title: The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis.
abstract: BACKGROUND
  The relationship between surgical age and long-term neuropsychological outcomes in sagittal-suture craniosynostosis remains equivocal. Whole-vault cranioplasty and strip craniectomy are performed at various times in individuals with sagittal-suture craniosynostosis. This study used comprehensive neurological testing to examine the relationship between age at time of surgery and long-term neuropsychological function.
  
  
  METHODS
  Seventy sagittal-suture craniosynostosis patients who had previously undergone either whole-vault cranioplasty or strip craniectomy were examined divided into three groups: treatment before 6 months (n = 41), between 6 and 12 months (n = 21), and after 12 months (n = 8). To examine long-term cognitive functioning, participants between the ages of 5 and 25 years underwent neurodevelopmental tests to evaluate intelligence, achievement, and learning disabilities.
  
  
  RESULTS
  Compared with those treated between 6 and 12 months and after 12 months, patients who underwent surgery before 6 months demonstrated higher full-scale IQ (p < 0.01) and verbal IQ (p < 0.01). Patients who received surgery before 6 months also demonstrated superior abilities in word reading (p < 0.01), reading comprehension (p < 0.01), spelling (p < 0.01), and numerical operations (p < 0.05) relative to those who had surgery between 6 and 12 months old. A statistically significant higher percentage of patients treated after 6 months had one or more reading-related learning disabilities as compared with those undergoing earlier surgery.
  
  
  CONCLUSIONS
  This study suggests that surgery before 6 months old results in improved long-term neurological outcomes. Future studies should examine how the technique of surgery impacts these neuropsychological measures.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New Haven and Hartford, Conn.; Charlottesville, Va.; Pittsburgh, Pa.; and DeKalb, Ill. From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine; the Craniofacial Surgery Center, Connecticut Children's Medical Center; the Department of Neurosurgery, University of Virginia School of Medicine; the University of Pittsburgh School of Medicine; and the Department of Psychology, Northern Illinois University.
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
authors.forename: Jenny F
authors.initials: JF
authors.lastname: Yang
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hashim
authors.forename: Roberto
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authors.lastname: Travieso
authors.forename: Jordan
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authors.lastname: Terner
authors.forename: Linda C
authors.initials: LC
authors.lastname: Mayes
authors.forename: Paul
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authors.lastname: Kanev
authors.forename: Charles
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authors.lastname: Duncan
authors.forename: John
authors.initials: J
authors.lastname: Jane
authors.forename: John
authors.initials: J
authors.lastname: Jane
authors.forename: Ian
authors.initials: I
authors.lastname: Pollack
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.forename: David J
authors.initials: DJ
authors.lastname: Bridgett
authors.forename: John A
authors.initials: JA
authors.lastname: Persing
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003398:Craniosynostoses / Q000601:surgery*; D006801:Humans; D007223:Infant; D007859:Learning Disabilities / Q000175:diagnosis / Q000453:epidemiology*; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult