Neuro-developmental outcome in sagittal synostosis; Analysis of 488 children in the context of the existing literature.

PURPOSE: The neurodevelopmental impact of sagittal synostosis (SS) remains controversial, with conflicting evidence regarding long-term cognitive and functional outcome. This report reviews the literature on neurodevelopmental outcome in SS and presents our experience with 488 children who underwent open, wide, strip craniectomy and were evaluated for long-term functional outcome. METHODS: A narrative literature review was conducted using PubMed and Google Scholar to identify studies reporting neurodevelopmental, cognitive, or functional outcomes in children with SS. In parallel, a retrospective cohort included children who underwent early, wide, open strip craniectomy for isolated SS between 1999 and 2022, with a minimum follow-up of two years. Functional outcomes were assessed using structured parental telephone questionnaires. RESULTS: Twenty-two original research articles and six review studies met inclusion criteria, showing heterogeneous methodologies but generally normal long-term neurodevelopmental outcome with occasional mild, domain-specific vulnerabilities. In our cohort, 488 children (397 males) had a mean follow-up of 9.4 ± 6.3 years (range 2-25). The majority demonstrated normal functional development. Educational support was rarely required, and no neurodevelopmental or functional limitations related to surgery were identified in adulthood. Among 386 children of school age, mild reading difficulties were reported in 8 children (2.3%). 3/488 patients (0.6%) required secondary surgical intervention. CONCLUSIONS: Both the literature review and our cohort suggest that children with isolated sagittal synostosis who undergo early surgical correction generally have favorable long-term functional and neurodevelopmental outcomes.