Consensus statement from the international consensus meeting on post-traumatic cranioplasty - Report - MDSpire
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International Consensus Meeting Findings on Cranioplasty Following Traumatic Brain Injury

  • By

  • C. Iaccarino

  • A. Kolias

  • P. D. Adelson

  • A. M. Rubiano

  • E. Viaroli

  • A. Buki

  • G. Cinalli

  • K. Fountas

  • T. Khan

  • S. Signoretti

  • V. Waran

  • A. O. Adeleye

  • R. Amorim

  • A. Bertuccio

  • A. Cama

  • R. M. Chesnut

  • P. De Bonis

  • A. Estraneo

  • A. Figaji

  • S. I. Florian

  • R. Formisano

  • P. Frassanito

  • C. Gatos

  • A. Germanò

  • C. Giussani

  • I. Hossain

  • P. Kasprzak

  • F. La Porta

  • D. Lindner

  • A. I. R. Maas

  • W. Paiva

  • P. Palma

  • K. B. Park

  • P. Peretta

  • A. Pompucci

  • J. Posti

  • S. K. Sengupta

  • A. Sinha

  • V. Sinha

  • R. Stefini

  • G. Talamonti

  • A. Tasiou

  • G. Zona

  • M. Zucchelli

  • P. J. Hutchinson

  • F. Servadei

  • December 22, 2020

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International Consensus on Cranioplasty After Traumatic Brain Injury

Overview

An international consensus meeting developed recommendations to optimize cranioplasty (CP) management following decompressive craniectomy (DC) for traumatic brain injury (TBI). Key topics included indications, surgical technique, materials, timing, hydrocephalus management, and pediatric considerations.

Background

Decompressive craniectomy is a common surgical intervention to control intracranial pressure and reduce mortality after severe TBI but results in skull defects requiring cranioplasty. Despite extensive literature on DC, guidelines lack specific recommendations on CP, leading to variability in clinical practice. The consensus meeting aimed to address these gaps by gathering global expert opinions to guide CP management.

Data Highlights

The consensus meeting involved international neurosurgical experts and rehabilitation physicians who reviewed literature and clinical experience across five key topics. Statements were voted on anonymously, requiring at least 70% agreement for inclusion. The methodology acknowledged the low level of high-quality evidence, relying on expert consensus to inform recommendations.

Key Findings

  • Cranioplasty is defined as reconstruction of the cranial vault following decompressive craniectomy performed for TBI.
  • There is wide variability in the size and extent of cranial defects post-DC, but guidelines recommend frontotemporoparietal DC of at least 12 cm × 15 cm or 15 cm diameter to improve outcomes.
  • Decision-making for cranioplasty should begin at the time of decompressive craniectomy, including surgical planning of skin incision, scalp trauma management, and dural closure.
  • The consensus addressed five fundamental topics: indications and technique, materials, timing, management of post-traumatic hydrocephalus, and pediatric CP considerations.
  • Due to limited high-quality evidence, a consensus-based approach was used rather than formal grading systems like GRADE.

Clinical Implications

Clinicians should incorporate cranioplasty planning into the initial decompressive craniectomy procedure to optimize outcomes. Awareness of the recommended cranial defect sizes and the need for multidisciplinary input, including rehabilitation specialists, is essential. The consensus recommendations provide a practical framework to standardize CP management despite limited high-level evidence.

Conclusion

This international consensus provides expert-guided recommendations to improve the management of cranioplasty following decompressive craniectomy in TBI patients. It highlights the need for early surgical planning and multidisciplinary collaboration to address current clinical uncertainties.

References

  1. Guidelines for the Management of Adult Severe TBI (4th Edition)
  2. International Consensus Meeting on Cranioplasty Following TBI, Naples 2018
  3. World Federation of Neurosurgical Societies Neurotrauma Committee

Original Source(s)

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

  • by C. Iaccarino, A. Kolias, P. D. Adelson, A. M. Rubiano, E. Viaroli, A. Buki, G. Cinalli, K. Fountas, T. Khan, S. Signoretti, V. Waran, A. O. Adeleye, R. Amorim, A. Bertuccio, A. Cama, R. M. Chesnut, P. De Bonis, A. Estraneo, A. Figaji, S. I. Florian, R. Formisano, P. Frassanito, C. Gatos, A. Germanò, C. Giussani, I. Hossain, P. Kasprzak, F. La Porta, D. Lindner, A. I. R. Maas, W. Paiva, P. Palma, K. B. Park, P. Peretta, A. Pompucci, J. Posti, S. K. Sengupta, A. Sinha, V. Sinha, R. Stefini, G. Talamonti, A. Tasiou, G. Zona, M. Zucchelli, P. J. Hutchinson, F. Servadei

  • December 22, 2020

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