C Iaccarino1, A Kolias2,3, P D Adelson4, A M Rubiano5, E Viaroli6, A Buki7, G Cinalli8, K Fountas9, T Khan10, S Signoretti11, V Waran12, A O Adeleye13, R Amorim14, A Bertuccio15, A Cama16, R M Chesnut17,18, P De Bonis19, A Estraneo20,21, A Figaji22, S I Florian23, R Formisano24, P Frassanito25, C Gatos26, A Germanò27, C Giussani28, I Hossain29, P Kasprzak30, F La Porta31, D Lindner32, A I R Maas33, W Paiva34, P Palma35, K B Park36, P Peretta37, A Pompucci38, J Posti39, S K Sengupta40, A Sinha41, V Sinha42, R Stefini43, G Talamonti44, A Tasiou26, G Zona45,46, M Zucchelli47, P J Hutchinson6, F Servadei48,49. 1. Division of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy. 2. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge Biomedical Campus, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK. ak721@cam.ac.uk. 3. NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK. ak721@cam.ac.uk. 4. Division of Neurosurgery/Children's Neuroscience, Department of Child Health, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA. 5. Neurosciences Institute, Neurosurgery Service, MEDITECH-INUB Research Group, El Bosque Clinic, El Bosque University, Bogotá, Colombia. 6. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge Biomedical Campus, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK. 7. Department of Neurosurgery, Pecs University, Pecs, Hungary. 8. Department of Neurosurgey, "Santobono-Posillipon" Children's Hospital, Naples, Italy. 9. Department of Neurosurgery, Universityof Thessaly, University Hospital of Larissa, Larissa, Greece. 10. Northwest General Hospital and Medical Center, Peshawar, Pakistan. 11. Department of Neurosurgery, "Sant'Eugenio" Hospital - ASL ROMA 2, Rome, Italy. 12. Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 13. Department of Neurological Surgery, University College Hospital, College of Medicine, University of Ibadan, Ibadan, Nigeria. 14. Division of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil. 15. Neurosurgical Unit, "SS. Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy. 16. Department of Pediatric Neurosurgery, Institute for Scientifict Research and Care "Giannina Gaslini", Genua, Italy. 17. Department of Neurological Surgery, School of Global Health Harborview Medical Center, University of Washington, Seattle, WA, USA. 18. Department of Orthopaedic Surgery, School of Global Health Harborview Medical Center, University of Washington, Seattle, WA, USA. 19. Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy. 20. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy. 21. Neurology Unit, Santa Maria della Pietà General Hospital, Nola, Italy. 22. Division of Neurosurgery, Neuroscience Institute, University of Cape Town, Red Cross Children's Hospital, Rondebosch, Cape Town, South Africa. 23. Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania. 24. Post-Coma Unit, IRCCS Santa Lucia Foundation, Rome, Italy. 25. Department of Pediatric Neurosurgery, "University Cattolica del Sacro Cuore- School of Medicine "A. Gemelli", Rome, Italy. 26. Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Thessaly, Greece. 27. Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy. 28. Neurosurgery, Department of Surgery and Translational Medicine, Milan Centre for Neuroscience, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy. 29. Department of Neurosurgery, Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland. 30. Department of Neurosurgery, Medical University of Lodz, Łódź, Poland. 31. Neurorehabilitation Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. 32. Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany. 33. Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. 34. Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 35. Department of Pediatric Neurosurgery, "Bambin Gesù" Children's Hospital, Rome, Italy. 36. Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. 37. Department of Pediatric Neurosurgery, "Città della Salute e della Scienza di Torino - Presidio ospedaliero Regina Margherita", Turin, Italy. 38. Department of Neurosurgery, ASL Latina "Santa Maria Goretti" Hospital, Latina, Italy. 39. Department of Neurosurgery and Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland. 40. Department of Neurosurgery, Command Hospital Kolkata, Kolkata, India. 41. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. 42. Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India. 43. Departiment of Neurosurgery, ASS T-Ovest Milanese, Legnano Hospital, Milan, Italy. 44. Department of Neurosurgery, "Niguarda" Hospital, Milan, Italy. 45. Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 46. Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy. 47. Section of Pediatric Neurosurgery, Institute for Scientifict Research and Care "Bellaria", Bologna, Italy. 48. Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy. 49. Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
Abstract
BACKGROUND: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. METHODS: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. RESULTS: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. CONCLUSIONS: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
BACKGROUND: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. METHODS: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. RESULTS: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. CONCLUSIONS: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
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