학술논문
Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel
Document Type
article
Author
Corrado Iaccarino; Salvatore Chibbaro; Thomas Sauvigny; Ivan Timofeev; Ismail Zaed; Silvio Franchetti; Harry Mee; Antonio Belli; Andras Buki; Pasquale De Bonis; Andreas K. Demetriades; Bart Depreitere; Kostantinos Fountas; Mario Ganau; Antonino Germanò; Peter Hutchinson; Angelos Kolias; Dirk Lindner; Laura Lippa; Niklas Marklund; Catherine McMahon; Dorothee Mielke; Davide Nasi; Wilco Peul; Maria Antonia Poca; Angelo Pompucci; Jussi P. Posti; Nicoleta-Larisa Serban; Bruno Splavski; Ioan Stefan Florian; Anastasia Tasiou; Gianluigi Zona; Franco Servadei
Source
Brain and Spine, Vol 4, Iss , Pp 102761- (2024)
Subject
Language
English
ISSN
2772-5294
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.