Craniosynostosis: contemporary surgical strategies and timing- evolving concepts in technique selection, neurodevelopment, syndromic disease, and multidisciplinary care

Abstract Craniosynostosis is a heterogeneous craniofacial disorder defined by premature fusion of one or more cranial sutures, resulting in abnormal skull growth and, in some cases, elevated intracranial pressure and neurodevelopmental compromise. Advances in pediatric neurosurgery, craniofacial surgery, and molecular genetics have substantially altered both the understanding and management of this condition. Endoscopic-assisted techniques have emerged as an alternative to traditional open cranial vault remodeling, particularly for early-presenting nonsyndromic cases, while open techniques remain essential for complex and syndromic craniosynostosis. Parallel progress in genetics has reframed craniosynostosis as a disorder of cranial suture biology, with defined molecular pathways influencing phenotype, progression, and outcome. This narrative review discusses contemporary surgical strategies, the timing of intervention in relation to neurocognitive development, challenges unique to syndromic craniosynostosis, and the expanding role of genetics and multidisciplinary care. The review aims to provide an integrated, clinically oriented perspective suitable for neurosurgical practice rather than a systematic comparison of outcomes.