Neurocognitive and behavioral outcomes in metopic synostosis: relation to severity and surgical timing

BACKGROUND: Developmental and behavioral issues are frequently reported in patients with metopic synostosis. The effect of pre-operative severity and surgical timing on these outcomes remains debated and inconclusive. This study aims to describe neurocognitive profiles in patients with metopic synostosis and evaluate associations with pre-operative severity and surgical timing. METHODS: A retrospective study was conducted on patients with non-syndromic metopic synostosis who underwent fronto-orbital advancement (FOA) at Sophia Children's Hospital. Patients were born between 2006-2018 and had a minimum 6-year follow-up. Data from psychological/psychiatric diagnostic assessments were collected, including WPPSI and WISC. Pre-operative severity was determined using CranioRate. RESULTS: A total of 228 patients with non-syndromic metopic synostosis who underwent FOA (median age 10 months, IQR 8-12) were included. Among these, 48.2% had reported parental concerns regarding their child's developmental and behavioral functioning. In total, 99 patients underwent psychological/psychiatric assessment, of which 73 patients underwent assessment at our center at the mean age of 7.8 years. Among referred patients, full scale IQ (FSIQ) (mean 95.5, p 0.012) and processing speed index (mean 94.3, p 0.002) were significantly lower compared to normative means. No significant association was found between FSIQ and pre-operative severity or surgical timing. Among all patients who underwent assessment, 43 were diagnosed with attention deficit/hyperactivity disorder and 13 were diagnosed with autism spectrum disorder, representing 18.9% and 5.7% of the total cohort respectively. CONCLUSION: In this single-center cohort, cognitive and behavioral outcomes in children with metopic synostosis are not associated with pre-operative severity or surgical timing. However, parental concerns are common, and the increased prevalence of behavioral problems in this population highlights the importance of long-term neurodevelopmental monitoring.