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  • 作者或编辑器:Annahita r . Fotouhix
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神经development in unilateral coronal craniosynostosis: a systematic review and meta-analysis

Annahita R. Fotouhi, Sarah N. Chiang, Andrew M. Peterson, Michelle M. Doering, Gary B. Skolnick, Sybill D. Naidoo, Jennifer M. Strahle, Sean D. McEvoy, and Kamlesh B. Patel

OBJECTIVE

The current literature on unilateral coronal craniosynostosis is replete with repair techniques and surgical outcomes; however, information regarding neurodevelopment remains unclear. Therefore, the aim of this systematic review and meta-analysis was to comprehensively assess the neurodevelopmental outcomes of patients with unicoronal craniosynostosis compared with their healthy peers or normative data.

开云体育世界杯赔率

系统回顾的奥维德MEDLINE和Embase, Web of Science, Scopus, Cochrane Library, andClinicalTrials.govdatabases from database inception to January 19, 2022, was performed. Included studies assessed neurodevelopment of patients with unicoronal craniosynostosis. Two independent reviewers selected studies and extracted data based on a priori inclusion and exclusion criteria. Results of developmental tests were compared with normative data or controls to generate Hedges’ g statistics for meta-analysis. The quality of included studies was evaluated using the National Institutes of Health Assessment Tool.

RESULTS

A total of 19 studies were included and analyzed, with an overall fair reporting quality. A meta-analysis of 325 postoperative patients demonstrated that scores of general neurodevelopment were below average but within one standard deviation of the norm (Hedges’ g = −0.68 [95% CI −0.90 to −0.45], p < 0.001). Similarly, postoperative patients exhibited lower scores in verbal, psychomotor, and mathematic outcome assessments.

CONCLUSIONS

This systematic review and meta-analysis found that patients with unicoronal craniosynostosis had poorer neurodevelopment, although scores generally remained within the normal range. These data may guide implementation of regular neurocognitive assessments and early learning support of patients with unicoronal craniosynostosis.

InJournal of Neurosurgery: Pediatrics Volume 31: Issue 1 (Jan 2023)

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School-age anthropometric and patient-reported outcomes after open or endoscopic repair of sagittal craniosynostosis

Annahita R. Fotouhi, Kamlesh B. Patel, Gary B. Skolnick, Corinne M. Merrill, Katherine M. Hofmann, Esperanza Mantilla-Rivas, Brent R. Collett, Virginia D. Allhusen, Sybill D. Naidoo, Gary F. Rogers, Robert F. Keating, Matthew D. Smyth, and Suresh N. Magge

OBJECTIVE

Several studies have compared perioperative parameters and early postoperative morphology between endoscope-assisted strip craniectomy with orthotic therapy (endoscopic repair) and cranial vault remodeling (open repair). To extend these results, the authors evaluated school-age anthropometric outcomes after these techniques across three institutions.

开云体育世界杯赔率

学龄儿童(年龄范围4-18年)with previously corrected isolated sagittal craniosynostosis were enrolled. Upon inclusion, 3D photographs and patient-reported outcomes were obtained, and the cephalic index and head circumference z-scores were calculated. Analyses of covariance models controlling for baseline differences and a priori covariates were performed.

RESULTS

Eighty-one participants (median [range] age 7 [4–15] years) were included. The mean (95% CI) school-age cephalic index was significantly higher in the endoscopic cohort, though within the normal range for both groups (endoscopic 78% [77%–79%] vs open 76% [74%–77%], p = 0.027). The mean change in the cephalic index from preoperation to school age was significantly greater in the endoscopic group (9% [7%–11%] vs open 3% [1%–5%], p < 0.001). Compared to preoperative measurements, mean school-age head circumference z-scores decreased significantly more in the open cohort (−1.6 [−2.2 to −1.0] vs endoscopic −0.3 [−0.8 to −0.2], p = 0.002). Patient-reported levels of stigma were within the normal limits for both groups.

CONCLUSIONS

Endoscopic and open repair techniques effectively normalize school-age anthropometric outcomes. However, endoscopic repair produces a clinically meaningful and significantly greater improvement in the school-age cephalic index, with maintenance of head growth. These findings demonstrate the importance of early referral by pediatricians and inform treatment decisions.

InJournal of Neurosurgery: Pediatrics Publish Before Print

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