Neurodevelopmental Outcomes in Craniosynostosis Repair

NCT ID: NCT04072783

Last Updated: 2025-02-24

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 9 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-07-08
• Study Completion Date: 2024-12-31

Brief Summary

Context: Craniosynostosis is a common craniofacial abnormality which can be associated with various clinical syndromes. Though it has been established that children with craniosynostosis score lower on certain developmental tests, the effect of craniosynostosis and cranioplasty surgery on the neural circuitry and brain development is less well known or understood.

Objectives: The purpose of this study is to describe the effect of cranial vault remodeling in children with craniosynostosis on white matter tracts with tractography and Diffusion tensor imaging (DTI), functional MRI, and neurodevelopmental tests, before and after surgery as compared to age-matched controls.

Study Design: This will be a prospective study of patients diagnosed with craniosynostosis and who are going to have open or endoscopic cranial vault remodeling (CVR).

Study Measures: The study will measure MRI sequences before and after surgery and at set time intervals to quantify the effect of white matter tract maturity. Parallel to this, neurodevelopmental tests will be administered at these same intervals.

Detailed Description

Craniosynostosis, the premature ossification and fusion of one or more cranial sutures, is a common craniofacial abnormality occurring in 1 of 2,000 live births. 1 2 Craniosynostosis can lead to increased intra-cranial pressure in between 12-50% of those affected which may have delayed neuro developmental implications.

The crucial neurodevelopment occurs in the first years of life and is most rapidly progressing during the first year of life. Premature closure of the cranial sutures decrease the intracranial volume and space available for the rapidly developing brain. Cranial vault remodeling (CVR) is the current standard of care to mitigate any possible developmental delay secondary to craniosynostosis and also improve the head shape. CVR is a combined surgery between the neurosurgeon who takes off the cranial bone/bones, and the craniofacial surgeon who assists and reconstructs the cranium with absorbable plates and screws.

After surgery, although there is no doubt that there is an improvement in head shape, the craniofacial skeleton and the soft tissues, but there is less data, and virtually no functional imaging information available addressing the effect of CVR surgery on the growing brain.

The main objective of this project would be to begin to explore the relationship of CVR and it requisite effects on the growing brain with a cohort of patients who are set to undergo CVR, while performing a battery of neurodevelopmental and imaging studies pre- and post-operatively and compare with normative controls. This is one part of a three-center study collaborating with craniofacial units at Yale University and Wake Forest University in which similar, if not identical protocols will be carried out. We hope that analyses of these data will provide better insight into and greater definition of the effect of CVR and the secondarily available increase in intra-cranial volume on the growing brain in the clinical setting of craniosynostosis.

Conditions

Craniosynostoses

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: NONE

Study Groups

Patients with craniosynostosis

Patients with craniosynostosis will undergo pre - and post-operative imaging studies. The surgery will be performed for these patients as standard of care. They will also be tested fro neurodevelopment.

Group Type: OTHER

MRI,DTI, functional MRI

Intervention Type: DIAGNOSTIC_TEST

1. Patients will undergo testing with Pre- and and post-surgical MRI. The protocol will be Sagittal T1, Axial inversion recovery, T2, fluid-attenuated inversion recovery, susceptibility weighted image, diffusion weighted images, diffusion tensor imaging, resting state fMRI, sagittal 3D GRE / FFE or 3D T1 VIBE and tractography.

2. Once patients are identified, surgery is planned.The standard of care procedures fall into two categories based on age of presentation, clinician judgement and family preference all other things being equal. Both the endoscopic-assisted craniectomy and open CVR are standard of care procedures. Patients self-select into these groups. None of the surgery nor any aspect of it is experimental.

3. Patients are routinely examined for neurodevelopment pre- and post-operatively as part of American Cleft Palate Craniofacial Association guidelines.The Vineland Adaptive Behavior Scales are used up to and including age 4.

Interventions

MRI,DTI, functional MRI

1. Patients will undergo testing with Pre- and and post-surgical MRI. The protocol will be Sagittal T1, Axial inversion recovery, T2, fluid-attenuated inversion recovery, susceptibility weighted image, diffusion weighted images, diffusion tensor imaging, resting state fMRI, sagittal 3D GRE / FFE or 3D T1 VIBE and tractography.

2. Once patients are identified, surgery is planned.The standard of care procedures fall into two categories based on age of presentation, clinician judgement and family preference all other things being equal. Both the endoscopic-assisted craniectomy and open CVR are standard of care procedures. Patients self-select into these groups. None of the surgery nor any aspect of it is experimental.

3. Patients are routinely examined for neurodevelopment pre- and post-operatively as part of American Cleft Palate Craniofacial Association guidelines.The Vineland Adaptive Behavior Scales are used up to and including age 4.

Intervention Type: DIAGNOSTIC_TEST

Other Intervention Names

Neurodevelopmental testing, surgery

Eligibility Criteria

Inclusion Criteria

• Up to 500 children, for all subjects, age of initial study entry: one test group between 3-6 months old( endoscopic assisted) , and the other 6-24 months of age ( open CVR) ) once enrolled, children will be included until 4 years of age.
• Diagnosed with craniosynostosis, single or multiple suture
• Babies with craniosynostosis syndrome including but not limited to Pfieffers, Aperts, Crouzons,and Menkes.
• Approximately 60 age-matched controls (3 in each group) not diagnosed with craniosynostosis syndrome, stratified by age groups starting at 3 months, 5 months, 7 months, 9 month 11 months, 13 months, 15 months, 17 months, 19 months, then every 3 months, 22 months, 25 months, 28 months, 31 months, 34 months, 37 months,40 months,43 months,46 months,49 months.

• Children with traumatic brain injury, brain cancer, or VP shunt that could affect development.
• Children who have already undergone CVR repair
• Developmentally Normal children who cannot undergo or cannot be still for an awake or asleep non-sedated MRI

• Maximum Eligible Age: 4 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Arkansas

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Eylem Ocal, MD

Role: PRINCIPAL_INVESTIGATOR

University of Arkansas

Locations

University of Arkansas for Medical Sciences

Little Rock, Arkansas, United States

Countries

United States

Other Identifiers

217610

Identifier Type: -

Identifier Source: org_study_id