Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

Corrado Iaccarino^{1

2

3}, Salvatore Chibbaro⁴, Thomas Sauvigny⁵, Ivan Timofeev⁶, Ismail Zaed⁷, Silvio Franchetti³, Harry Mee^{6

8

9}, Antonio Belli¹⁰, Andras Buki¹¹, Pasquale De Bonis¹², Andreas K Demetriades^{13

14}, Bart Depreitere¹⁵, Kostantinos Fountas¹⁶, Mario Ganau¹⁷, Antonino Germanò¹⁸, Peter Hutchinson¹⁹, Angelos Kolias¹⁹, Dirk Lindner²⁰, Laura Lippa²¹, Niklas Marklund²², Catherine McMahon²³, Dorothee Mielke²⁴, Davide Nasi²⁵, Wilco Peul²⁶, Maria Antonia Poca^{27

28

29}, Angelo Pompucci³⁰, Jussi P Posti³¹, Nicoleta-Larisa Serban³², Bruno Splavski^{33

34}, Ioan Stefan Florian³², Anastasia Tasiou¹⁶, Gianluigi Zona^{35

36}, Franco Servadei^{37

38}

Affiliations

¹ School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
² Neurosurgery Unit, University Hospital of Modena, Modena, Italy.
³ Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy.
⁴ Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy.
⁵ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁷ Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
⁸ Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK.
⁹ NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK.
¹⁰ The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹¹ Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden.
¹² Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy.
¹³ Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
¹⁴ Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK.
¹⁵ Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium.
¹⁶ Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹⁷ Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹⁸ Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy.
¹⁹ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
²⁰ Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany.
²¹ Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy.
²² Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden.
²³ Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK.
²⁴ Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
²⁵ Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy.
²⁶ University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands.
²⁷ Centre de Recerca Matemàtica (CRM), Bellaterra, Spain.
²⁸ Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain.
²⁹ Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain.
³⁰ Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy.
³¹ Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland.
³² Department of Neurosurgery, Cluj Emergency Hospital, Cluj-Napoca, Romania.
³³ Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia.
³⁴ Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia.
³⁵ IRCCS Ospedale Policlinico San Martino, Genova, Italy.
³⁶ Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
³⁷ IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
³⁸ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

PMID: 38510640
PMCID: PMC10951750
DOI: 10.1016/j.bas.2024.102761

Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

Corrado Iaccarino et al. Brain Spine. 2024.

. 2024 Jan 26:4:102761.

doi: 10.1016/j.bas.2024.102761. eCollection 2024.

Authors

Affiliations

¹ School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
² Neurosurgery Unit, University Hospital of Modena, Modena, Italy.
³ Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy.
⁴ Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy.
⁵ Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁷ Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
⁸ Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK.
⁹ NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK.
¹⁰ The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹¹ Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden.
¹² Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy.
¹³ Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
¹⁴ Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK.
¹⁵ Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium.
¹⁶ Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
¹⁷ Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹⁸ Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy.
¹⁹ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
²⁰ Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany.
²¹ Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy.
²² Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden.
²³ Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK.
²⁴ Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.
²⁵ Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy.
²⁶ University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands.
²⁷ Centre de Recerca Matemàtica (CRM), Bellaterra, Spain.
²⁸ Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain.
²⁹ Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain.
³⁰ Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy.
³¹ Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland.
³² Department of Neurosurgery, Cluj Emergency Hospital, Cluj-Napoca, Romania.
³³ Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia.
³⁴ Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia.
³⁵ IRCCS Ospedale Policlinico San Martino, Genova, Italy.
³⁶ Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.
³⁷ IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
³⁸ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

PMID: 38510640
PMCID: PMC10951750
DOI: 10.1016/j.bas.2024.102761

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.

Keywords: Cranioplasty; Diagnosis; Post-traumatic hydrocephalus; Surgical strategy.

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Conflict of interest statement

No conflict of interest is to be disclosed by Salvatore Chibbaro, Thomas Sauvigny, Ivan Timofeev, Harry Mee, and Ismail Zaed. Corrado Iaccarino received educational grants from 10.13039/100009006Integra Lifescience. Franco Servadei received consultancy and speaker fees from Finceramica, Integra Life Sciences, and Upsurgeon. Silvio Franchetti received education grants producing HA.

Figures

**Fig. 1**
Delphi flow chart. Outline of the principal steps of the Delphi process as it was performed in this study.

See this image and copyright information in PMC

References

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Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

Affiliations

Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources