Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

Peter J. Hutchinson, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK. pjah2@cam.ac.uk.
Angelos G. Kolias, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
Tamara Tajsic, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
Amos Adeleye, Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Abenezer Tirsit Aklilu, Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Tedy Apriawan, Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia.
Abdul Hafid Bajamal, Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia.
Ernest J. Barthélemy, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
B Indira Devi, Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India.
Dhananjaya Bhat, Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India.
Diederik Bulters, Wessex Neurological Centre, University Hospital Southampton, Southampton, UK.
Randall Chesnut, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Giuseppe Citerio, School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
D Jamie Cooper, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Marek Czosnyka, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
Idara Edem, Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Nasser M. El-Ghandour, Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Anthony Figaji, Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Kostas N. Fountas, Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece.
Clare Gallagher, Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Gregory W. Hawryluk, Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Corrado Iaccarino, Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
Mathew Joseph, Department of Neurosurgery, Christian Medical College, Vellore, India.
Tariq Khan, Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan.
Tsegazeab Laeke, Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Oleg Levchenko, Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.
Baiyun Liu, Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China.
Weiming Liu, Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China.
Andrew Maas, Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
Geoffrey T. Manley, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
Paul Manson, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Anna T. Mazzeo, Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy.

Document Type

Article

Abstract

BACKGROUND: Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach. METHODS: The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries. RESULTS: The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval. CONCLUSIONS: In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Medical Subject Headings

Brain Injuries, Traumatic (complications, surgery); Consensus; Decompressive Craniectomy (methods); Humans; Intracranial Hypertension (etiology, surgery)

Publication Date

7-1-2019

Publication Title

Acta neurochirurgica

E-ISSN

0942-0940

Volume

161

Issue

7

First Page

1261

Last Page

1274

PubMed ID

31134383

Digital Object Identifier (DOI)

10.1007/s00701-019-03936-y

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