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.

Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel / Iaccarino, C.; Chibbaro, S.; Sauvigny, T.; Timofeev, I.; Zaed, I.; Franchetti, S.; Mee, H.; Belli, A.; Buki, A.; De Bonis, P.; Demetriades, A. K.; Depreitere, B.; Fountas, K.; Ganau, M.; Germano, A.; Hutchinson, P.; Kolias, A.; Lindner, D.; Lippa, L.; Marklund, N.; Mcmahon, C.; Mielke, D.; Nasi, D.; Peul, W.; Poca, M. A.; Pompucci, A.; Posti, J. P.; Serban, N. -L.; Splavski, B.; Florian, I. S.; Tasiou, A.; Zona, G.; Servadei, F.. - In: BRAIN AND SPINE. - ISSN 2772-5294. - 4:(2024), pp. N/A-N/A. [10.1016/j.bas.2024.102761]

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

Iaccarino C.;Franchetti S.;
2024

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.
2024
4
N/A
N/A
Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel / Iaccarino, C.; Chibbaro, S.; Sauvigny, T.; Timofeev, I.; Zaed, I.; Franchetti, S.; Mee, H.; Belli, A.; Buki, A.; De Bonis, P.; Demetriades, A. K.; Depreitere, B.; Fountas, K.; Ganau, M.; Germano, A.; Hutchinson, P.; Kolias, A.; Lindner, D.; Lippa, L.; Marklund, N.; Mcmahon, C.; Mielke, D.; Nasi, D.; Peul, W.; Poca, M. A.; Pompucci, A.; Posti, J. P.; Serban, N. -L.; Splavski, B.; Florian, I. S.; Tasiou, A.; Zona, G.; Servadei, F.. - In: BRAIN AND SPINE. - ISSN 2772-5294. - 4:(2024), pp. N/A-N/A. [10.1016/j.bas.2024.102761]
Iaccarino, C.; Chibbaro, S.; Sauvigny, T.; Timofeev, I.; Zaed, I.; Franchetti, S.; Mee, H.; Belli, A.; Buki, A.; De Bonis, P.; Demetriades, A. K.; Depreitere, B.; Fountas, K.; Ganau, M.; Germano, A.; Hutchinson, P.; Kolias, A.; Lindner, D.; Lippa, L.; Marklund, N.; Mcmahon, C.; Mielke, D.; Nasi, D.; Peul, W.; Poca, M. A.; Pompucci, A.; Posti, J. P.; Serban, N. -L.; Splavski, B.; Florian, I. S.; Tasiou, A.; Zona, G.; Servadei, F.
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