Single-Suture Craniosynostosis: A Review of Neurobehavioral Research and Theory
1 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle; 2 Department of Surgery, Northwestern University, Chicago; 3 Department of Pediatrics, University of Washington, Seattle; 4 Department of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri; 5 Department of Psychology, University of Washington, Seattle
All correspondence concerning this article should be addressed to Matthew L. Speltz, CHRMC, 4800 Sand Point Way, N.E., MS CL-08, Seattle, WA 98105. E-mail: mspeltz{at}u.washington.edu.
Objective To review research and theory regarding the neurobehavioral correlates and outcomes of single-suture, or isolated, craniosynostosis in children. Methods A critical review of 17 studies of the hypothesized association between isolated craniosynostosis and neurodevelopment. Results Isolated craniosynostosis is associated with a three- to fivefold increase in risk for cognitive deficits or learning/language disabilities. The causal basis for this association is unclear. No particular calvarial suture (sagittal, metopic, left or right unilateral coronal) has been associated with higher risk of problems. There is little evidence from quasi-experimental studies that cranioplastic surgery prevents or reduces risk of neurobehavioral impairment. Conclusions Future studies would benefit from larger samples and larger control groups; measures of specific neuropsychological functions (in addition to global cognition); analyses of neuropsychological status in relation to the severity and cortical impact of synostosis; and an examination of interactions between synostosis and social/family risk factors on neurodevelopment. Routine neurodevelopmental screening of young children with isolated craniosynostosis is recommended.
Key words: craniosynostosis; neuropsychology; cranioplasty.