Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel
Brain and Spine, vol. 4, pp. 102761
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.
Authors 33
-
University of Modena and Reggio Emilia · Azienda Sanitaria Unità Locale di Reggio Emilia · Azienda Ospedaliero-Universitaria di Modena
Affiliation as printed
Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
Neurosurgery Unit, University Hospital of Modena, Modena, Italy
School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
-
University of Siena · Hôpitaux Universitaires de Strasbourg
Affiliation as printed
Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy
Neurosurgery Department, Strasbourg University Hospitals, Strasbourg, France
-
University Medical Center Hamburg-Eppendorf
Affiliation as printed
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
-
Cambridge University Hospitals NHS Foundation Trust · Addenbrooke's Hospital
Affiliation as printed
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
-
Ospedale regionale di Lugano · Ente Ospedaliero Cantonale
Affiliation as printed
Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland
-
Azienda Sanitaria Unità Locale di Reggio Emilia
Affiliation as printed
Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
-
University of Cambridge · Cambridge University Hospitals NHS Foundation Trust · Addenbrooke's Hospital
Affiliation as printed
Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK
NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK
-
University Hospitals Birmingham NHS Foundation Trust
Affiliation as printed
The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
-
Humanitas University · Örebro University
Affiliation as printed
Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
-
University of Ferrara · Arcispedale Sant'Anna
Affiliation as printed
Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy
-
Edinburgh Royal Infirmary · Ospedale Santa Maria Goretti
Affiliation as printed
Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
-
Universitair Ziekenhuis Leuven
Affiliation as printed
Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
-
Affiliation as printed
Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
-
University of Oxford · Oxford University Hospitals NHS Trust
Affiliation as printed
Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
-
Affiliation as printed
Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
-
University of Cambridge · Addenbrooke's Hospital
Affiliation as printed
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
-
University of Cambridge · Addenbrooke's Hospital
Affiliation as printed
Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
-
Affiliation as printed
Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
-
Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Affiliation as printed
Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy
-
Lund University · Skåne University Hospital
Affiliation as printed
Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
-
Walton Centre · Opća bolnica Dubrovnik
Affiliation as printed
Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
-
Affiliation as printed
Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
-
Azienda Ospedaliero-Universitaria di Modena
Affiliation as printed
Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy
-
Wilco C. Peul Aachen
Leiden University · Humanitas University · Leiden University Medical Center · IRCCS Humanitas Research Hospital
Affiliation as printed
University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands
Corresponding author. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
-
Universitat Autònoma de Barcelona · Centre de Recerca Matemàtica · Vall d'Hebron Hospital Universitari
Affiliation as printed
Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain
-
Affiliation as printed
Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
-
Affiliation as printed
Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland
-
Spitalul Clinic Județean de Urgență Cluj-Napoca
Affiliation as printed
Department of Neurosurgery, Cluj Emergency Hospital, Cluj-Napoca, Romania
-
University of Applied Health Sciences · Opća bolnica Dubrovnik
Affiliation as printed
Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia
Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
-
Spitalul Clinic Județean de Urgență Cluj-Napoca
Affiliation as printed
Department of Neurosurgery, Cluj Emergency Hospital, Cluj-Napoca, Romania
-
Affiliation as printed
Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
-
Ospedale Santa Maria Goretti · Ospedale Policlinico San Martino · Addenbrooke's Hospital · University of Genoa
Affiliation as printed
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
IRCCS Ospedale Policlinico San Martino, Genova, Italy
Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
block Addenbrookes Hospital, Cambridge, UK
-
Franco Servadei corresponding
Humanitas University · IRCCS Humanitas Research Hospital
Affiliation as printed
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Neurosurgery Unit I, Cranial and Spinal Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Cited by 31 stored of 31
No patents citing this paper on Lens.org (checked 2026-10-11).