Neurodevelopmental and Psychiatric Outcomes in Pediatric Nonsyndromic Craniosynostosis: Insights for Plastic Surgery From a Retrospective Risk Analysis.

INTRODUCTION

Despite advances in surgical treatment, uncertainty remains regarding the long-term neurodevelopmental outcomes of patients with craniosynostosis. This study aimed to investigate associations between clinical features of craniosynostosis and multiple neurodevelopmental comorbidities.

METHODS

We retrospectively reviewed patients with nonsyndromic craniosynostosis at a single institution (2003-2023), examining demographics, clinical presentation, neurocognitive diagnoses, surgeries, and patient outcomes. Descriptive statistics, chi-square tests, t tests, and logistic regressions were performed using STATA ( P  < 0.05).

RESULTS

We analyzed 655 pediatric craniosynostosis patients with a median follow-up of 50 (21-90) months. Overall, 64.3% were male, 83.0% were White, and the median age at diagnosis of craniosynostosis was 11.03 (3.65-43.89) months. A total of 121 patients had a neurodevelopmental diagnosis (ASD, ADHD, learning disorder, or developmental delay), including 74 with multiple diagnoses.Neurodevelopmental diagnoses were associated with later craniosynostosis diagnosis (57.62 ± 44.56 vs 30.10 ± 41.21; P  < 0.001), older age at first PRS visit (48.63 ± 40.75 vs 29.15 ± 41.21; P  < 0.001), and longer PRS follow-up (81.70 ± 54.71 vs 57.73 ± 47.58; P  = 0.002). In models adjusted for age at initial visit, surgical intervention, insurance type, race, sex, and suture location, each additional month of age at CS diagnosis was independently associated with a 2% increase in the odds of any neurodevelopmental outcome ( P  < 0.001). Age at surgery was not significantly associated.

CONCLUSION

This study underscores the critical importance of early diagnosis in craniosynostosis, as delayed detection was associated with increased frequency of a composite outcome of 4 common neurodevelopmental disorders in pediatric patients. However, without systematic syndrome classification, the causal nature of this relationship remains uncertain and warrants further investigation.