The Boston Method for Sagittal Craniosynostosis Correction: Technique Description and Early Outcomes.
TL;DR
The Boston Method is an effective, safe, reproducible technique for sagittal craniosynostosis that achieves consistent morphologic correction through geometry-driven posterior vault remodeling that produces biparietal widening and occipital expansion and elevation, while preserving anterior cranial structures.
Abstract
Background
Sagittal craniosynostosis produces a characteristic cranial deformity resulting from restricted transverse growth and compensatory anteroposterior elongation. Multiple open cranial vault remodeling techniques are used. However, achieving controlled morphologic correction and intracranial volume expansion while preserving uninvolved structures remains challenging. The Boston Method is a geometry-driven approach that emphasizes posterior vault remodeling to address biparietal narrowing and occipital deformity.
Methods
A retrospective, single-center cohort study was performed, including consecutive patients with nonsyndromic sagittal craniosynostosis treated using the Boston Method between March 1, 2020 and February 28, 2026. Demographic, perioperative, and postoperative data were collected. The primary outcome was quantitative morphologic assessment using cephalic index (CI) measurements from preoperative and postoperative imaging. Secondary outcomes included perioperative characteristics and transfusion outcomes, including those associated with virtual surgical planning (VSP).
Results
Twenty patients were included [mean age: 27.9 (SD 20.4) months]. VSP was used in 11 (55%). Mean operative time was 327.4 (SD 40.8) minutes. Mean intraoperative and total RBC transfusion volumes were lower in the VSP subgroup (116.3 versus 143 mL). Nine (45%) patients required no transfusion. Consistent morphologic correction was observed, including biparietal widening, occipital elevation, and normalization of cranial proportions. Quantitative assessment showed a significant increase in mean CI from 70.7 preoperatively to 76.0 postoperatively (mean change: 5.3±2.7, P<0.001). No patients required reoperation.
Conclusion
The Boston Method is an effective, safe, reproducible technique for sagittal craniosynostosis that achieves consistent morphologic correction through geometry-driven posterior vault remodeling. It produces biparietal widening and occipital expansion and elevation, while preserving anterior cranial structures.