Nuances of Managing Delayed Presenting Sagittal Craniosynostosis

Sagittal craniosynostosis is the most common form of craniosynostosis and may present with a spectrum of disease severity. Severe forms are typically identified early and subsequently treated with prompt surgical intervention. On the other end of the spectrum, subtle cases without overt signs of elevated intracranial pressure nor exaggerated cranial deformity may present late in childhood, well past the age at which typical cranial vault remodeling techniques are performed. In these cases, special care must be taken to appropriately monitor and intervene surgically when indicated. The purpose of this article is to outline the current guidelines for identifying and monitoring delayed presenting sagittal craniosynostosis, the indications for conservative versus surgical management, commonly utilized interventions, and provide insight gained from institutional experiences.