Neurocognitive outcomes in children with craniosynostosis after surgical correction: a narrative review

Importance: Craniosynostosis, the premature fusion of cranial sutures, carries significant clinical implications beyond skull morphology. Its restriction of brain growth and potential for raised intracranial pressure pose notable risks for long-term neurocognitive development. Both syndromic and nonsyndromic forms have been increasingly associated with deficits in cognition, behavior, and academic performance, underlining the need for careful neurodevelopmental monitoring even after surgical intervention. Observations: Current literature demonstrates heterogeneous neurocognitive outcomes post-surgery. While early surgical correction, particularly before 6 months of age, is associated with improved cognitive trajectories, especially in sagittal synostosis, results remain inconsistent across craniosynostosis subtypes and surgical approaches. Syndromic cases generally fare worse than nonsyndromic ones, regardless of surgical timing. Notably, emerging evidence reveals that even children with single-suture, nonsyndromic craniosynostosis may experience subtle yet meaningful impairments in executive function, language, and attention. Variability in surgical technique, assessment tools, and follow-up duration complicates the interpretation of outcomes. Conclusions and Relevance: Although surgical correction remains the cornerstone of management, it does not uniformly normalize neurocognitive development. The findings underscore the necessity of a multidisciplinary, longitudinal approach to care - integrating neurosurgical, neuropsychological, and rehabilitative strategies. Future research must prioritize standardized cognitive assessments, extended follow-up into adolescence, and controlled comparisons across surgical methods. Understanding genetic, environmental, and procedural moderators of outcome is essential to optimizing long-term quality of life for affected children.