Long-Term Intracranial and Ophthalmologic Outcomes in Single Suture Craniosynostosis

Introduction: Long-term intracranial and ophthalmologic sequelae are incompletely characterized for single suture craniosynostosis at a population level. Prior studies are limited by small cohorts and short follow-up. Methods: A retrospective cohort study was performed using the Pediatric Health Information System (PHIS) from 2015 to 2024. Children with single-suture craniosynostosis undergoing surgical correction were included. Patients with syndromic and genetic comorbidities were excluded. Prevalence of intracranial diagnoses was compared by suture type. Multivariate logistic regression assessed the association between surgical timing and outcomes, adjusting for gender, race/ethnicity, and suture type. Results: A total of 1602 children met the inclusion criteria (mean follow-up 5.3±3.6 y). Sagittal synostosis was associated with elevated intracranial pressure (ICP) (6.3%), unicoronal synostosis with ophthalmologic complications (23.6%), and lambdoid synostosis with Chiari I malformation (17.9%) (all P <0.05). Compared with surgery before 6 months, surgery at 1 to 2 years was associated with increased odds of elevated intracranial pressure (OR: 2.19, 95% CI: 1.09–4.43, P =0.029) and hydrocephalus (OR: 3.79, 95% CI: 1.41–10.23, P =0.008). Surgery at 2 to 4 years was associated with increased odds of elevated intracranial pressure (OR: 4.98, 95% CI: 2.57–9.66), Chiari malformation (OR: 5.50, 95% CI: 2.40–12.62) (all P ≤0.002), and hydrocephalus (OR: 3.17, 95% CI: 1.07–9.42, P =0.037). Surgical age was not associated with ophthalmologic outcomes among patients with unicoronal synostosis. Conclusions: These findings characterize the prevalence of long-term intracranial morbidity for single suture craniosynostosis on a national scale and emphasize the importance of suture-specific long-term postoperative surveillance.