Introduction: Craniosynostosis is a congenital condition

characterized by premature fusion of one or more

cranial sutures, affecting approximately 5.9 per 10,000

live births worldwide and presenting as either

syndromic or nonsyndromic.1-3 Premature suture

fusion restricts normal skull growth and may result in

elevated intracranial pressure, disrupted brain

development, and progressive orbital abnormalities.4

Surgical correction is the mainstay of management,

with intervention commonly performed between 4–8

months of age.5, 8-10 However, national data

demonstrate that many children undergo surgery

beyond this window.11 Delayed surgery may increase

complications and adverse outcomes, but its long-

term effects remain unclear.

Purpose: 

To evaluate the impact of delayed cranial vault

reconstruction (≥13 months) on perioperative,

neurodevelopmental, and ophthalmologic

outcomes in patients with nonsyndromic single-

suture craniosynostosis.

Methods: 

Design:

• Retrospective cohort study (2014–2021) at a single

tertiary craniofacial center

Patients:

• Nonsyndromic single-suture craniosynostosis (NSCS)

• Underwent open cranial vault reconstruction (CVR)

• ≥1 year multidisciplinary follow-up (plastic surgery +

neurosurgery)

Statistical Analysis:

• t-test, Wilcoxon, Chi-square, Fisher’s exact

• Multivariable logistic and linear regression

• Significance: p < 0.05

• Software: R (v4.4.1)

Conclusion: 

 Later surgery (≥13 months) was associated with longer operative

times but not increased perioperative risk.

• Developmental delays and therapy needs were similar regardless of

surgical timing.

• Later surgery was associated with a higher overall burden of mental

health diagnoses.

• Later surgery (≥13 months) was associated with higher rates of

postoperative ptosis.

• Earlier surgery (<13 months) was associated with higher rates of

pathologic astigmatism.

• Comorbidities and prematurity were stronger predictors of

developmental outcomes than surgical age.

• Delayed surgery was most commonly driven by diagnostic oversight

and missed early recognition.

• Later surgery was associated with older age at referral and longer

times from referral to surgery.

• Overall delayed surgery appears safe perioperatively but may

influence select neuropsychiatric and ophthalmologic outcomes,

underscoring the importance of early recognition and referral.