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

Abstract

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. 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). 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. 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.