Five year follow-up with Neuropsychologist

On 31 August 2011 we headed along to the Plastic & Maxillofacial Surgery Unit at the Royal Children's Hospital in Melbourne to meet with the Neuropsychologist to whom we had been referred by the Neurosurgeon at Connor's routine five year old check up.  We were basically meeting her prior to meeting the Plastic Surgeon so we would know if there were any developmental delays indicating pressure on the brain.  This would of course add to any possible cosmetic issues such as future facial distortion that might result from the lump on Connor's head.

The appointment was a two hour epic.  We met at 10am and spent about twenty minutes giving some background to the Neuropsychologist on Connor's medical history, personal background and general behaviour and development from a parent's point of view.  She then commenced twenty minutes of tests followed by a break for twenty minutes then a further thirty or forty minutes of additional tests.  

The tests were called the Wechsler Preschool & Primary Scale of Intelligence - Third Edition; NEPSY Developmental Neuropsychological Assessment.  They ranged from verbal tests such as naming pictures, giving definitions for words or describing items, to arranging patterns with blocks or picking patterns in pictures.  The report which she forwarded me later covered Test Behaviours, Intellectual Abilities, Information Processing and Visuomotor Speed, Attention and Executive Functions, New Learning and Memory.

Overall her assessment was that Connor is fine although he was a little impulsive and distractible with subtle difficulty with regulating his responses on testing.  To me it seemed he was just shy performing for a stranger but I guess these might be the subtle issues that are interesting to a neuropsychologist.  She mentioned that we should keep an eye on his school progress and if any decline is noted in behaviour or academic progress we should bring him back for reassessment in case pressure on his brain becomes an issue, I guess.  Apparently children with a history of cranial abnormality are at risk of experiencing mild developmental delays.  So one appointment down, one more to go...

Five year follow-up with Neurosurgeon

Connor is a beautiful looking four and a half year old, progressing like any other child his age.  I had however, been worried about a kind of half egg shaped lump on the top of his head.  Unless I rub his head I cannot notice it.  He has thick hair so any small head shape imprefections probably wouldn't be very obvious anyway.  I did remember though that Dr Jeffrey Wisoff (http://www.med.nyu.edu/biosketch/jhw1), our fabulous Pediatric Neurosurgeon at NYU had mentioned at our one year surgery follow-up appointment that ordinarily, should we remain in the US, we would have a five year follow up appointment with him.  This would be the last appointment required.  It would usually be just a formality to ensure the head was shaping correctly in the growing child.  As we were moving back to Australia, we asked if he could recommend a Neurosurgeon in Australia, knowing that he had recently travelled to a worldwide conference.  He recommended Charlie Teo.  At the time the name meant nothing, but now that I am back in Australia, I know Charlie Teo as a bit of a media personality, probably the reason Dr Wisoff recalled his name as a recommendation also.

In any case, after Connor turned four I mentioned to our family doctor that I would like a referral to a local Pediatric Neurosurgeon in Melbourne, where we are now living in Australia.  He referred me to the Royal Children's Hospital, which has an excellent reputation, particularly in the area of craniofacial work.  The recent separation of conjoined twins from Bangladesh had brought quite a bit of attention (http://www.theage.com.au/national/beginning-life-apart-20091118-ikzz.html).  I had also read an article in the paper about work they had done with children with Scaphacephaly, so I was quite looking forward to the appointment and their view of Connor's New York operation.

I was really thinking of the appointment as a formality.  A final sign-off.  I was quite taken aback when, on meeting Dr Patrick Lo (http://www.laccon.com/about.html), the Pediatric Nurosurgeon to whom I was referred, he seemed concerned about the shaping of Connor's head.  He said that although, as a Neurosurgeon, he can say that the surgery looks fine, it is not the type that they perform at the Royal Children's, as they prefer to insert springs to allow for brain growth.  He said that we really needed a referral to the Craniofacial unit to see a Plastic Surgeon.  Although Connor looks fine now, it is important to confirm that the lump on his head and general skull shaping will not have any detrimental effect on skull or facial shape in future as Connor grows.

Needless to say, I was a little concerned and my husband was very worried about the possibility of the prospect of new surgery.  I have since received my referral to the Plastic Surgeon for an assessent on 9 September 2011.  In the meantime a Pediatric Neuropsychologist from the Royal Children's Hospital called me up to determine if we should make an appointment with her prior to the Plastic Surgeon appointment.  This appointment would be to conduct a developmental assessment to ensure that the head shaping issue is not also causing an kind of brain pressure affecting development.  This would also, of course influence any further surgery decisions - being in addition to cosmetic concerns.  This appointment will be on 31 August.  She sounded interesting as she works with children with craniosynostosis and had a few developmental traits that she said were common.  Language, concentration and self-regulation of moods were some areas she said she had noticed. 

I figure the Neuropsychologist is an interesting thing to do anyway.  No harm really.  But I am not looking forward to the Plastic Surgeon.  Oh well, here we go again.