Background: Craniosynostosis is a congenital condition characterized by premature fusion of one or more cranial sutures, potentially impairing brain development. Early surgical correction is widely recommended, but the influence of specific variables such as age at surgery, number and type of affected sutures, and surgical technique on long-term functional outcomes remains under investigation.

Objective: To evaluate the relationship between functional outcomes and (1) age at the time of surgery, (2) number and type of affected cranial sutures, and (3) type of surgical intervention in patients with primary non-syndromic craniosynostosis.

Methods: This retrospective analytical study included 58 children with primary non-syndromic craniosynostosis who underwent surgical treatment at El Sahel Teaching Hospital between July 2009 and July 2020. Patients were assessed five years postoperatively using the Stanford-Binet Intelligence Scales, Fifth Edition (SB5), and the Assessment and Programming of Psycho-Motor Skills (APPS) to evaluate cognitive and psychomotor outcomes, respectively. Statistical analysis was performed using SPSS v25.0, with significance set at P < 0.05.

Results: The mean age at surgery was 6.79 ± 4.9 months. A strong negative correlation was found between age at surgery and SB5 score (r = –0.521, P < 0.001), indicating better cognitive outcomes with earlier intervention. Patients operated upon at ≤6 months had significantly higher SB5 scores compared to those treated at older ages (P < 0.001). APPS scores were also higher in younger age groups, though the difference was not statistically significant (P = 0.278). A greater number of affected sutures was associated with poorer outcomes in both SB5 and APPS scores (P < 0.001). Patients with unicoronal or metopic synostosis had better outcomes, while pansynostosis and metopic-bicoronal involvement were linked to lower scores. Suturectomy was associated with significantly better outcomes than reconstructive surgery (SB5: P < 0.001; APPS: P = 0.04).

Conclusion: Early surgical intervention, fewer affected sutures, and suturectomy were all associated with improved cognitive and psychomotor outcomes in patients with non-syndromic craniosynostosis. These findings support the prioritization of early diagnosis and minimally invasive surgical approaches to optimize long-term neurodevelopmental outcomes. Adoption of standardized neurodevelopmental tools such as the Stanford-Binet Intelligence Scales and the APPS test is recommended to evaluate cognitive and psychomotor outcomes of such cases periodically before and after the procedure.