Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

Peter J Hutchinson^{1

2}, Angelos G Kolias^{3

4}, Tamara Tajsic^{3

4}, Amos Adeleye^{5

6}, Abenezer Tirsit Aklilu^{7

8}, Tedy Apriawan⁹, Abdul Hafid Bajamal⁹, Ernest J Barthélemy¹⁰, B Indira Devi¹¹, Dhananjaya Bhat¹¹, Diederik Bulters¹², Randall Chesnut¹³, Giuseppe Citerio^{14

15}, D Jamie Cooper^{16

17}, Marek Czosnyka³, Idara Edem¹⁸, Nasser M F El-Ghandour¹⁹, Anthony Figaji²⁰, Kostas N Fountas²¹, Clare Gallagher²², Gregory W J Hawryluk²³, Corrado Iaccarino²⁴, Mathew Joseph²⁵, Tariq Khan²⁶, Tsegazeab Laeke^{7

8}, Oleg Levchenko²⁷, Baiyun Liu²⁸, Weiming Liu²⁸, Andrew Maas²⁹, Geoffrey T Manley³⁰, Paul Manson³¹, Anna T Mazzeo³², David K Menon³³, Daniel B Michael³⁴, Susanne Muehlschlegel³⁵, David O Okonkwo³⁶, Kee B Park³⁷, Jeffrey V Rosenfeld^{38

39}, Gail Rosseau⁴⁰, Andres M Rubiano^{41

42}, Hamisi K Shabani⁴³, Nino Stocchetti^{44

45}, Shelly D Timmons⁴⁶, Ivan Timofeev³, Chris Uff^{47

48}, Jamie S Ullman⁴⁹, Alex Valadka⁵⁰, Vicknes Waran⁵¹, Adam Wells⁵², Mark H Wilson⁵³, Franco Servadei⁵⁴

Affiliations

¹ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK. pjah2@cam.ac.uk.
² NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK. pjah2@cam.ac.uk.
³ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
⁴ NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
⁵ Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁶ Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria.
⁷ Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁸ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
⁹ Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia.
¹⁰ Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India.
¹² Wessex Neurological Centre, University Hospital Southampton, Southampton, UK.
¹³ Harborview Medical Center, University of Washington, Seattle, WA, USA.
¹⁴ School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
¹⁵ Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy.
¹⁶ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
¹⁷ Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia.
¹⁸ Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁹ Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
²⁰ Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
²¹ Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece.
²² Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
²³ Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁴ Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
²⁵ Department of Neurosurgery, Christian Medical College, Vellore, India.
²⁶ Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan.
²⁷ Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.
²⁸ Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China.
²⁹ Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
³⁰ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
³¹ Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
³² Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy.
³³ Division of Anaesthesia, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
³⁴ Oakland University William Beaumont School of Medicine and Michigan Head & Spine Institute, Auburn Hills, MI, USA.
³⁵ Departments of Neurology, Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
³⁶ Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³⁷ Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
³⁸ Department of Neurosurgery, Alfred Hospital, Melbourne, Australia.
³⁹ Department of Surgery, Monash University, Melbourne, Australia.
⁴⁰ George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
⁴¹ INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia.
⁴² MEDITECH Foundation, Clinical Research, Cali, Colombia.
⁴³ Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania.
⁴⁴ Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
⁴⁵ Neuroscience Intensive Care Unit, Department of Anaesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁴⁶ Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA.
⁴⁷ Department of Neurosurgery, The Royal London Hospital, London, UK.
⁴⁸ Queen Mary University of London, London, UK.
⁴⁹ Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
⁵⁰ Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA.
⁵¹ Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁵² Department of Neurosurgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.
⁵³ Imperial Neurotrauma Centre, Department of Surgery and Cancer, Imperial College, London, UK.
⁵⁴ Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy.

PMID: 31134383
PMCID: PMC6581926
DOI: 10.1007/s00701-019-03936-y

Review

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

Peter J Hutchinson et al. Acta Neurochir (Wien). 2019 Jul.

. 2019 Jul;161(7):1261-1274.

doi: 10.1007/s00701-019-03936-y. Epub 2019 May 28.

Authors

Affiliations

¹ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK. pjah2@cam.ac.uk.
² NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK. pjah2@cam.ac.uk.
³ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
⁴ NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
⁵ Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
⁶ Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria.
⁷ Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁸ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
⁹ Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia.
¹⁰ Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India.
¹² Wessex Neurological Centre, University Hospital Southampton, Southampton, UK.
¹³ Harborview Medical Center, University of Washington, Seattle, WA, USA.
¹⁴ School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
¹⁵ Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy.
¹⁶ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
¹⁷ Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia.
¹⁸ Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁹ Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
²⁰ Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
²¹ Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece.
²² Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
²³ Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
²⁴ Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
²⁵ Department of Neurosurgery, Christian Medical College, Vellore, India.
²⁶ Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan.
²⁷ Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.
²⁸ Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China.
²⁹ Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
³⁰ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
³¹ Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
³² Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy.
³³ Division of Anaesthesia, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
³⁴ Oakland University William Beaumont School of Medicine and Michigan Head & Spine Institute, Auburn Hills, MI, USA.
³⁵ Departments of Neurology, Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
³⁶ Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³⁷ Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
³⁸ Department of Neurosurgery, Alfred Hospital, Melbourne, Australia.
³⁹ Department of Surgery, Monash University, Melbourne, Australia.
⁴⁰ George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
⁴¹ INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia.
⁴² MEDITECH Foundation, Clinical Research, Cali, Colombia.
⁴³ Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania.
⁴⁴ Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
⁴⁵ Neuroscience Intensive Care Unit, Department of Anaesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁴⁶ Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA.
⁴⁷ Department of Neurosurgery, The Royal London Hospital, London, UK.
⁴⁸ Queen Mary University of London, London, UK.
⁴⁹ Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
⁵⁰ Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA.
⁵¹ Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁵² Department of Neurosurgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia.
⁵³ Imperial Neurotrauma Centre, Department of Surgery and Cancer, Imperial College, London, UK.
⁵⁴ Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy.

PMID: 31134383
PMCID: PMC6581926
DOI: 10.1007/s00701-019-03936-y

Abstract

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.

Keywords: Cranioplasty; Decompression; Neurosurgery; Neurotrauma.

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Conflict of interest statement

Peter J. Hutchinson is the Chief Investigator of the RESCUEicp and RESCUE-ASDH randomised trials. Giuseppe Citerio has received honoraria for serving as a speaker from Codman/Integra and Neurooptics. D. Jamie Cooper is the Chief Investigator for the DECRA trial. Marek Czosnyka receives part of licencing fee Part of licensing fee for ICM+ Software (Cambridge Enterprise Ltd). Corrado Iaccarino has a consultant contract for post-market Surveillance for FINCERAMICA S.p.A. Franco Servadei has received personal fees from Takeda Pharmaceutical Company, grants and personal fees from Integra LifeSciences, and grants and personal fees from Finceramica SpA. The rest of the authors declare that they have no conflict of interest related to this manuscript.

References

1. Amorim RL, Bor-Seng-Shu E, S Gattás G, Paiva W, de Andrade AF, Teixeira M. Decompressive craniectomy and cerebral blood flow regulation in head injured patients: a case studied by perfusion CT. J Neuroradiol. 2012;39:346–349. - PubMed
1. Archavlis E, Carvi Y, Nievas M. The impact of timing of cranioplasty in patients with large cranial defects after decompressive craniectomy. Acta Neurochir. 2012;154:1055–1062. - PubMed
1. Badri S, Chen J, Barber J, Temkin NR, Dikmen SS, Chesnut RM, et al. Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. Intensive Care Med. 2012;38:1800–1809. - PubMed
1. Balestreri M, Czosnyka M, Hutchinson P, Steiner LA, Hiler M, Smielewski P, et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury. Neurocrit Care. 2006;4:8–13. - PubMed
1. Beauchamp KM, Kashuk J, Moore EE, Bolles G, Rabb C, Seinfeld J, et al. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? J Trauma. 2010;69:270–274. - PubMed

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Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

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Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

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Abstract

Conflict of interest statement

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