Brain and Spine (Jan 2024)
Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel
- Corrado Iaccarino,
- Salvatore Chibbaro,
- Thomas Sauvigny,
- Ivan Timofeev,
- Ismail Zaed,
- Silvio Franchetti,
- Harry Mee,
- Antonio Belli,
- Andras Buki,
- Pasquale De Bonis,
- Andreas K. Demetriades,
- Bart Depreitere,
- Kostantinos Fountas,
- Mario Ganau,
- Antonino Germanò,
- Peter Hutchinson,
- Angelos Kolias,
- Dirk Lindner,
- Laura Lippa,
- Niklas Marklund,
- Catherine McMahon,
- Dorothee Mielke,
- Davide Nasi,
- Wilco Peul,
- Maria Antonia Poca,
- Angelo Pompucci,
- Jussi P. Posti,
- Nicoleta-Larisa Serban,
- Bruno Splavski,
- Ioan Stefan Florian,
- Anastasia Tasiou,
- Gianluigi Zona,
- Franco Servadei
Affiliations
- Corrado Iaccarino
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Neurosurgery Unit, University Hospital of Modena, Modena, Italy; Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
- Salvatore Chibbaro
- Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy
- Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
- Silvio Franchetti
- Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
- Harry Mee
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK; NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK
- Antonio Belli
- The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Andras Buki
- Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden
- Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy
- Andreas K. Demetriades
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK; Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
- Bart Depreitere
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
- Kostantinos Fountas
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
- Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
- Dirk Lindner
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
- Laura Lippa
- Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy
- Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
- Catherine McMahon
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
- Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
- Davide Nasi
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy
- Wilco Peul
- University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands
- Maria Antonia Poca
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain; Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain
- Angelo Pompucci
- Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
- Jussi P. Posti
- Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland
- Nicoleta-Larisa Serban
- Department of Neurosurgery, Cluj Emergency Hospital, Cluj-Napoca, Romania
- Bruno Splavski
- Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia; Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
- Ioan Stefan Florian
- Department of Neurosurgery, Cluj Emergency Hospital, Cluj-Napoca, Romania
- Anastasia Tasiou
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Gianluigi Zona
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Franco Servadei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Corresponding author. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- Journal volume & issue
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Vol. 4
p. 102761
Abstract
Introduction: Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance. Research question: This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems. Methods: After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: ''Diagnostic criteria for PTH'' and ''Surgical strategies for PTH and cranial reconstruction.'' Results: The panel reached a consensus on 29 statements. In the ''Diagnostic criteria for PTH'' section, five statements were deemed ''appropriate'' (consensus 74.2−90.3 %), two were labeled ''inappropriate,'' and seven were marked as ''uncertain.''In the ''Surgical strategies for PTH and cranial reconstruction'' section, four statements were considered ''appropriate'' (consensus 74.2−90.4 %), six were ''inappropriate,'' and five were ''uncertain.'' Discussion and conclusion: Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.
