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
- 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."
InIntroduction
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.…
