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

At a Glance

CategoryDetail
ConditionPost-traumatic cranioplasty following decompressive craniectomy for traumatic brain injury
Key MechanismsReconstruction of skull defect after decompressive craniectomy to manage intracranial pressure and improve neurological outcomes
Target PopulationPatients with traumatic brain injury undergoing decompressive craniectomy, including pediatric patients and those with post-traumatic hydrocephalus
Care SettingNeurosurgical and neurotrauma care settings, including intensive care and rehabilitation

Key Highlights

  • Decompressive craniectomy controls intracranial pressure and reduces mortality but requires subsequent cranioplasty to reconstruct skull defects.
  • There is a lack of high-quality evidence and formal guidelines on cranioplasty indications, timing, materials, and techniques.
  • An international consensus meeting used expert panel discussions and voting to develop recommendations addressing five key topics: indications and technique, materials, timing, hydrocephalus management, and pediatric considerations.

Guideline-Based Recommendations

Diagnosis

  • Assess size and location of cranial defect post-decompressive craniectomy, with frontotemporoparietal DC defined as not less than 12 cm × 15 cm or 15 cm diameter.
  • Evaluate for post-traumatic hydrocephalus in patients following decompressive craniectomy.

Management

  • Plan cranioplasty at the time of decompressive craniectomy considering skin incision, scalp trauma, and dural closure to optimize subsequent reconstruction.
  • Use consensus-based recommendations to guide choice of surgical technique and materials due to limited high-quality evidence.
  • Include multidisciplinary teams, such as Physical Medicine and Rehabilitation physicians, especially when managing hydrocephalus and timing of cranioplasty.

Monitoring & Follow-up

  • Monitor neurological and psychological outcomes post-cranioplasty given the impact of cranial defects of varying sizes.
  • Use consensus-derived clinical indicators to guide timing and management of cranioplasty and associated complications.

Risks

  • Recognize that decompressive craniectomy and subsequent cranioplasty carry significant complication risks.
  • Consider risks related to timing, surgical technique, and material choice in cranioplasty planning.

Patient & Prescribing Data

Patients with traumatic brain injury requiring decompressive craniectomy and subsequent cranioplasty, including pediatric patients and those with hydrocephalus.

Due to low-level evidence and retrospective studies predominating, treatment decisions rely on expert consensus emphasizing individualized surgical planning and timing.

Clinical Best Practices

  • Initiate cranioplasty planning during the initial decompressive craniectomy surgery to optimize outcomes.
  • Adopt a multidisciplinary approach involving neurosurgeons and rehabilitation specialists for comprehensive care.
  • Use consensus-based recommendations to guide clinical decisions in the absence of high-quality randomized controlled trials.
  • Consider the size and location of cranial defects carefully as both small and large defects can have significant neurological and psychological effects.
  • Refine clinical protocols based on ongoing expert consensus and emerging evidence.

References

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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