What is the ideal age for surgery in single-suture craniosynostosis?

The optimal timing for surgical intervention in single-suture craniosynostosis (SSC) remains debated, despite advances in minimally invasive and open reconstructive approaches. This work integrates Children's National Medical Center (CNMC) institutional data with current literature to clarify age-related outcomes and guide timing recommendations. Published series from CMNC were analyzed and outcomes included perioperative morbidity, morphometric correction, intracranial pressure, and revision rates. Findings were contextualized with recent systematic reviews and multicenter data. Early endoscopic repair (≤ 4 months) yielded superior morphometric gains, lower blood loss, and shorter hospital stays. O'Brien et al. demonstrated a 2-4-month "sweet spot" for sagittal synostosis1, while Lajthia et al. confirmed excellent outcomes for metopic deformities in the same age range2. Open reconstruction at 9-12 months achieved durable aesthetic correction with low complication rates3. Delayed presentations were associated with elevated intracranial pressure but benefited from surgical decompression4. Meta-analyses corroborate these trends. CNMC's experience and global evidence converge on an early-infancy window (2-4 months) as optimal for endoscopic repair. Open cranial vault reconstruction remains effective for older infants or complex anatomy. Surgical timing should balance biological potential, institutional resources, and neurodevelopmental opportunity.