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 , Franco Servadei
{"title":"欧洲小组就颅骨成形术和创伤后脑积水的诊断和手术治疗提出的共识性建议","authors":"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 , Franco Servadei","doi":"10.1016/j.bas.2024.102761","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Research question</h3><p>This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems.</p></div><div><h3>Methods</h3><p>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.\"</p></div><div><h3>Results</h3><p>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.\"</p><p>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.\"</p></div><div><h3>Discussion and conclusion</h3><p>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.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000171/pdfft?md5=2658d98eac368822d11ea0a7bc4f27dc&pid=1-s2.0-S2772529424000171-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel\",\"authors\":\"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 , Franco Servadei\",\"doi\":\"10.1016/j.bas.2024.102761\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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.</p></div><div><h3>Research question</h3><p>This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems.</p></div><div><h3>Methods</h3><p>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.\\\"</p></div><div><h3>Results</h3><p>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.\\\"</p><p>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.\\\"</p></div><div><h3>Discussion and conclusion</h3><p>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. 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Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel
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.