Improved Global and Locomotor Development Folowing Surgery for Sagittal Synostosis

Twenty eight children with sagittal synostosis (SS) were assessed pre- and postoperatively and their psychomotor development was compared with that in 28 normal controls and with 13 children with SS without surgical intervention, in a prospective longitudinal design study at St James’s University Hospital, Leeds, UK. Using the Griffiths Mental Developmental Scales, children with SS had significantly lower gross locomotor function scores than normal controls, 35.7% having LD scores, when tested at a mean age of 8 months. Following surgical intervention (at a mean age of 6.9 months), the global development improved (p=0.001), locomotor deficit resolved (p=0.0001), often suddenly, particularly the delay in head control, and the developmental attainment continued to improve over time (11 children had a second postoperative assessment and 4 had a third). A lesser improvement was demonstrated in eye-hand coordination and performance skills (p=0.05). Children with SS not surgically corrected failed to show the improvement in development demonstrated in operated cases. Surgery for SS is more than a cosmetic procedure, but the mechanism for the improved development is not definitely determined. [1]

COMMENT. The authors list three novel findings: 1) the quantifiable delay in early development of infants with sagittal synostosis (SS) demonstrated in a controlled, prospective, longitudinal study; 2) a preoperative delay in gross locomotor development; and 3) a significant postoperative resolution of locomotor deficits. Previous studies have reported developmental delay only in older patients and without normal controls and prospective follow-up; mental rather than motor development has been considered; and delayed gross locomotor development with improvement after surgery has not previously been demonstrated in young infants. One study is cited that supports the present findings but in young children: 35.5% of 50 children with SS had cerebral palsy, psychomotor retardation, and/or neurological signs, and many of the deficits resolved after surgery, only 14.5% having persistent abnormal signs [2]. Raised intracranial pressure was considered an unlikely factor in the mechanism of improved locomotor function following surgery in the Leeds series.