Consensus statement from the international consensus meeting on post-traumatic cranioplasty

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.

Skull base repair following endonasal pituitary and skull base tumour resection: a systematic review

“…This prevented accurate meta-analysis on the comparative CSFR incidence for various repair techniques. We have previously described meta-analyses of CSFR in more defined populations, with analysis on selected repair technique effectiveness [ 8 , 149 ], however this paper aimed to capture the breadth of repair techniques and material currently in use. A useful future target would be the development of a standardised core data and/or outcome set to allow comprehensive quantitative synthesis of the literature.…”

“…Despite the purported advantages of endonasal approaches (TSA and EEA), postoperative cerebrospinal fluid rhinorrhoea (CSFR) remains a frequent complication, which may result in significant complications, including meningitis, pneumocephalus and the need for reoperation [ 6 – 8 ]. Reported CSFR rates are variable in the literature—generally up to 5% for TSA and up to 20% for EEA [ 7 , 9 , 10 ].…”

Syndrome of the trephined: clinical spectrum, risk factors, and impact of cranioplasty on neurologic recovery in a prospective cohort

“…Thus, earlier cranioplasty could improve the aptitude to perform rehabilitation activities in a physiologic vertical position. However, to fully understand the equation for optimal cranioplasty timing, multiple variables have to be considered, such as the cranioplasty-related complications [31], risk of infection [40], role of post-traumatic hydrocephalus [21], over-drainage related to ventriculoperitoneal shunting [21], pre-cranioplasty morbidity [7], bleeding diathesis, and conditions related to the initial etiology for a craniectomy.…”

Syndrome of the Trephined: Clinical Spectrum, Risk Factors, and Impact of Cranioplasty on Neurological Recovery in a Prospective Cohort

“…[24] Thus, earlier cranioplasty could improve the aptitude to perform rehabilitation activities in a seated or standing position. However, to fully understand the equation for optimal cranioplasty timing, multiple variables must be considered, such as the cranioplasty-related complications [31], risk of infection [40], role of post-traumatic hydrocephalus [21], over-drainage related to ventriculoperitoneal shunting [21], pre-cranioplasty morbidity [7], bleeding diathesis, and conditions related to the initial etiology for a craniectomy.…”

“…Our ndings, although preliminary, suggest an association between earlier cranioplasty and improved neurological recovery. Randomized trials with larger sample sizes are warranted [21] to explore this association, further controlling for multiple confounding factors and effect modi ers. Furthermore, cranioplasty is known to carry a high risk of postoperative complications, and therefore, post-operative hemorrhagic complications might mask the effect of cranioplasty on neurological improvement.…”