Consensus statement from the international consensus meeting on post-traumatic cranioplasty
Corrado Iaccarino, Angelos G. Kolias, P. David Adelson, Andrés M. Rubiano, Edoardo Viaroli, András Büki, Giuseppe Cinalli, Kostas N. Fountas, Tariq Khan, Stefano Signoretti, Vicknes Waran, Amos O. Adeleye, Robson Luís Oliveira de Amorim, Alessandro Bertuccio, Alessandro Cama, Randall M. Chesnut, Pasquale De Bonis, Anna Estraneo, Anthony Figaji, Ioan Ştefan Florian, Rita Formisano, Paolo Frassanito, Charalambos Gatos, A. Germanò, Carlo Giussani, Iftakher Hossain, Piotr Kasprzak, Fabio La Porta, Dirk Lindner, Andrew I.R. Maas, Wellingson Silva Paiva, Paolo Palma, K. B. Park, Paola Peretta, Angelo Pompucci, Jussi P. Posti, Sudip Kumar Sengupta, Ajay Sinha, Virendra Deo Sinha, Roberto Stefini, Giuseppe Talamonti, Αναστασία Τάσιου, Gianluigi Zona, Mino Zucchelli, Peter J. Hutchinson, Franco Servadei
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.