Background Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. Methods The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. Results The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. Conclusions In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Analysis of new and existing geophysical data for the Central Indian and Wharton Basins of the Indian Ocean were used to understand the formation and evolution of the Ninetyeast Ridge (NER), especially its relationship to the Kerguelen hot spot and the Wharton spreading ridge. Satellite gravity data and magnetic anomalies 34 through 19 define crustal isochrons and show fracture zones striking ∼N5°E. One of these, at 89°E, crosses the ∼N10°E trending NER, impacting the NER morphology. From 77 to 43 Ma the NER lengthened at a rate of ∼118 km/Myr, twice that of the ∼48–58 km/Myr accretion rate of adjacent oceanic crust. This difference can be explained by southward jumps of the Wharton spreading ridge toward the hot spot, which transferred portions of crust from the Antarctic plate to the Indian plate, lengthening the NER. Magnetic anomalies document a small number of large spreading ridge jumps in the ocean crust immediately to the west of the NER, especially two leaving observable 65 and 42 Ma fossil spreading ridges. In contrast, complex magnetic anomaly progressions and morphology imply that smaller spreading ridge jumps occurred at more frequent intervals beneath the NER. Comparison of the NER dates and magnetic anomaly ages implies that the hot spot first emplaced NER volcanoes on the Indian plate at a distance from the Wharton Ridge, but as the northward drifting spreading ridge approached the hot spot, the two interacted, keeping later NER volcanism near the spreading ridge crest by spreading center jumps.

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[1] Ninetyeast Ridge (NER) is a linear volcanic ridge in the Indian Ocean thought to have formed by hotspot volcanism on the northward-drifting Indian plate. Geological data from the ridge are sparse, so its tectonic evolution is poorly known. We studied satellite-derived gravity data, seismic reflection profiles, and multibeam bathymetry to examine NER structure. Gravity data show that the ridge displays a series of nearly E-W trending lineations with average spacing ∼0.4°(45 km). In seismic and bathymetry data, these lineations correlate with horsts and grabens that probably formed near the time of ridge emplacement. From their extensional nature and trends, we infer that these faulted structures formed near the spreading ridge that separated the Indian and Antarctic plates and their ubiquity implies the hotspot was never far from this spreading ridge.

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