Abstract: Long-Term Outcomes at Skeletal Maturity Following Cranial Vault Remodeling and Fronto-Orbital Advancement for Metopic Craniosynostosis

INTRODUCTION: As the third most frequent type, metopic craniosynostosis presents with a trigone-shaped skull and parieto-occipital bossing. Standard of care reconstruction includes an anterior cranial vault remodeling with fronto-orbital advancement. A paucity of literature exists regarding the long-term anthropometric outcomes and neurocognitive assessment in this patient population. METHODS: A prospectively maintained database of patients at the NYU Department of Plastic Surgery was retrospectively reviewed to identify patients who underwent open surgery for metopic craniosynostosis. Inclusion criteria consisted of patients who had a diagnosis of metopic craniosynostosis, pre-operative photographs, a history of an open procedure, and were amenable to late long-term follow-up. Patients were recalled for a comprehensive interview, examination and 2D/3D digital photography. RESULTS: Forty-one patients met inclusion criteria. Mean age at the time of follow-up was 14.3 years with a mean age of 10.3 months at surgery. The majority of patients, 83%, underwent only one operation. In total, 33% of patients underwent physical therapy or occupational therapy while 37.5% had speech therapy at some point during development. Learning disabilities were identified in 21% of patients with 8.3% of patients held back academically or requiring remediation. 8.3% of patients had diagnoses of anxiety, depression, and attention deficit disorder while 4.2% had autism, dyslexia, obsessive compulsive disorder, or oppositional defiance disorder. On physical examination at late follow-up, temporal hollowing was noted in 83% of patients. Persistent calvarial defects greater than 1cm2 were identified in 8.3%. Another 12.5% of patients had significant irregularities in frontal bone contour following remodeling. CONCLUSION: Open cranial vault remodeling with fronto-orbital advancement is a safe and reproducible procedure with excellent literature to support short-term outcomes. However, little data exist to evaluate this patient population as they mature. Our study critically evaluates physical exam findings, neurocognitive development, and anthropometric assessments in this patient population at or near skeletal maturity. MAIN OBJECTIVES: Learners will understand the physical exam findings and neurocognitive long-term outcomes following open procedures for metopic craniosynostosis.

Abstract licence: CC BY-NC-ND

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