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Comparable Neurodevelopmental Outcomes Following Strip Craniectomy and Cranial Vault Remodeling Before 6 Months of Age
Andrew Salib
1, Samira Glaeser-Khan
1, William Bai
1, Victoria Kong
1, Martin Kauke-Navarro
1, Omar Allam
1, Michael Alperovich
1
1. Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven , CT, United States.
Background: The effect of surgical technique on long-term neurodevelopment in sagittal craniosynostosis remains unclear. We compared neurodevelopmental outcomes following strip craniectomy and cranial vault remodeling (CVR) performed before 6 months of age.
Methods: A retrospective cohort study was performed using the Epic Cosmos database from 2016-2024. Children with isolated sagittal craniosynostosis undergoing strip craniectomy or CVR before 6 months were included. Patients with syndromic craniosynostosis, multisuture disease, major neurologic comorbidities, or genetic disorders associated with neurodevelopmental impairment were excluded. Neurodevelopmental diagnoses included language, motor, psychological, conduct, autism spectrum, and attention-deficit/hyperactivity disorders. Multivariable logistic regression adjusted for sex, follow-up duration, social vulnerability index, and pediatric comorbidity index.
Results: A total of 1,233 children met inclusion criteria, including 724 undergoing strip craniectomy and 509 undergoing CVR. There were no differences between cohorts in language (18.4% vs 18.1%, p=0.895), motor (7.6% vs 6.3%, p=0.377), psychological (3.7% vs 2.8%, p=0.345), autism spectrum (3.6% vs 3.7%, p=0.896), or attention-deficit/hyperactivity disorders (1.8% vs 2.9%, p=0.182). Conduct disorders were more common after strip craniectomy (4.7% vs 2.4%, p=0.033). After adjustment, CVR remained associated with lower odds of conduct disorders (adjusted odds ratio 0.42, p=0.011), with no differences in other outcomes.
Conclusion: Strip craniectomy and CVR performed before 6 months are associated with comparable broad neurodevelopmental outcomes in sagittal craniosynostosis. Future studies should verify these findings using standardized neurocognitive testing.
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