Management of secondary intracranial hypertension in untreated craniosynostosis: a case series and literature review.

introductionCraniosynostosis is a congenital condition involving the premature fusion of cranial sutures, with a prevalence of 1 in 1,400-2,100 births. It can lead to intracranial hypertension (ICH), particularly in multi-suture cases, manifesting as headaches, papilledema, or neurodevelopmental delays. While early intervention is typically recommended, management of delayed or untreated cases remains a clinical challenge. CASES: We report a case series of four patients with untreated craniosynostosis who presented with symptoms of intracranial hypertension. All had surpassed the typical age window for corrective surgery. Each patient underwent cranial expansion procedures tailored to individual pathology. No cerebrospinal fluid (CSF) shunting was required. DISCUSSION: Calvarial reshaping surgeries achieved significant symptomatic relief and radiologic improvement. These outcomes support the role of cranial expansion over CSF shunting in selected patients. The series also highlights the feasibility and effectiveness of late intervention in complex craniosynostosis, especially when symptoms of raised ICP are evident.

conclusionCranial reshaping surgery can be a successful primary approach in managing untreated cases of craniosynostosis presenting with intracranial hypertension. Early identification and timely intervention remain crucial to prevent long-term neurological and visual complications.