Neurocognitive sequelae of scaphocephaly

Objective. Early cranioplasty for scaphocephaly has become routine in most countries. In addition to normalizing the shape of the skull, it has been f ound to decrease intracranial hypertension. Whether corrective surgery bene fits the child's cognitive outcome has been poorly documented. Design. Eighteen children whose sagittal suture showed premature fusion at birth or soon thereafter were operated on at age 1 week to 7 months. All pa tients healed without complications and were followed-up at regular interva ls. At the age of 7.8 to 16.3 years they were examined to clarify their neu rocognitive development and to compare the results with their age- and gend er-matched healthy controls. Results. Originally scaphocephalic children, although operated on, had mild deficiencies in auditory short-term memory and language development when e xamined with the general comprehension, similarities, and digit span subsca les of the Wechsler Intelligence Scale for Children-Revised. In all other r espects their developmental outcome was equal to that of the controls. Conclusions. Despite relative early correction of the skull shape, original ly scaphocephalic children's neurocognitive performances do not reach the s ame level in all of the neurocognitive domains as their matched controls at school age. Early operation (less than or equal to 1 month) may decrease t his developmental delay. This implies that impairment of brain function has already taken place in utero. For the same reason an early operation seems to be justified not only for correction of the skull shape, but also to al low unrestricted development for the brain. Postponement of the operation w ould not serve either of these aims.