School results in single-suture craniosynostosis: what should we tell parents at the first consultation?

BACKGROUND: Parents of children diagnosed with nonsyndromic single-suture craniosynostosis (SSC) frequently ask whether school difficulties should be expected and what type of monitoring is appropriate over time. OBJECTIVE: To synthesize evidence on school-related outcomes in SSC and translate it into counselling guidance for the first consultation. METHODS: We conducted a structured narrative review with a systematic literature search. PubMed/MEDLINE and Scopus were searched from database inception to January 2026 using terms related to craniosynostosis, single-suture disease, school achievement, learning, cognition, attention, executive function, behaviour, and educational supports. Reference lists of included studies and relevant reviews were hand-searched. Eligible sources included controlled cohorts, longitudinal studies, population or registry studies, systematic reviews/meta-analyses, and clinically relevant studies reporting academic, neuropsychological, behavioural, or educational service outcomes in children with nonsyndromic SSC. Results were narratively synthesized by school-relevant domains. RESULTS: Mean intellectual and academic scores in SSC generally fall within normative ranges, with modest group differences and substantial overlap with peers. However, variability is increased, and a clinically meaningful subgroup shows learning vulnerabilities or requires educational supports. Mathematics, language-based learning processes, attention/executive function, and behaviour regulation are recurrent areas of concern. Population-linked and registry studies suggest that many children meet grade-level standards, while educational needs may emerge or become more visible as academic demands increase. Evidence for independent effects of surgical timing or technique on school-age cognition remains mixed and confounded. CONCLUSIONS: School outcomes in nonsyndromic SSC are generally favourable but heterogeneous. First-consultation counselling should combine realistic reassurance with anticipatory monitoring, attention to risk modifiers, and early collaboration with schools.