PURPOSE: Craniosynostosis (CS) is typically treated by cranial vault expansion (CVE) before one year of age. Some cases are diagnosed late, or present with non-specific symptoms of increased intracranial pressure (ICP). The purpose of this study is to review the symptoms, clinical findings, and outcomes of patients undergoing late CVE. METHODS: Retrospective chart review of 18 patients >2 years of age undergoing CVE. The 9 males and 9 females ranged from 25 months to 13 years (mean=6.8 yrs). Follow-up was 1 month to 6 years (mean=2.1 yrs). RESULTS: Thirteen patients had associated symptoms of increased ICP including headaches (HA's), nausea and vomiting (N/V), vision changes and photophobia. HA's were most common (9 patients), followed by vision changes (7 patients), N/V (5 patients), and photophobia (1 patient). Four patients with HA's and N/V had normal pre-operative CT scans. All patients with HA's, N/V, and photophobia had resolution of symptoms post-operatively. CONCLUSION: The diagnosis of increased ICP is difficult in the absence of papilledema or CT findings. Three patients had normal CT scans and only symptoms indicating increased ICP. Symptoms of increased ICP are improved with late CVE and are useful in determining who would benefit from an operation.