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

Hutchinson PJ 1 , Kolias AG 2 , Tajsic T 2 , Adeleye A 3 , Aklilu AT 4 , Apriawan T 5 Show all authors , Bajamal AH 5 , Barthélemy EJ 6 , Devi BI 7 , Bhat D 7 , Bulters D 8 , Chesnut R 9 , Citerio G 10 , Cooper DJ 11 , Czosnyka M 2 , Edem I 12 , El-Ghandour NMF 13 , Figaji A 14 , Fountas KN 15 , Gallagher C 16 , Hawryluk GWJ 17 , Iaccarino C 18 , Joseph M 19 , Khan T 20 , Laeke T 4 , Levchenko O 21 , Liu B 22 , Liu W 22 , Maas A 23 , Manley GT 24 , Manson P 25 , Mazzeo AT 26 , Menon DK 27 , Michael DB 28 , Muehlschlegel S 29 , Okonkwo DO 30 , Park KB 31 , Rosenfeld JV 32 , Rosseau G 33 , Rubiano AM 34 , Shabani HK 35 , Stocchetti N 36 , Timmons SD 37 , Timofeev I 2 , Uff C 38 , Ullman JS 39 , Valadka A 40 , Waran V 41 , Wells A 42 , Wilson MH 43 , Servadei F 44

Affiliations 

  • 1 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK. [email protected]
  • 2 Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
  • 3 Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
  • 4 Neurosurgical Unit, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  • 5 Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Soetomo General Hospital, Surabaya, Indonesia
  • 6 Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
  • 7 Department of Neurosurgery, National Institute for Mental Health and Neurosciences, Bangalore, India
  • 8 Wessex Neurological Centre, University Hospital Southampton, Southampton, UK
  • 9 Harborview Medical Center, University of Washington, Seattle, WA, USA
  • 10 School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
  • 11 Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
  • 12 Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
  • 13 Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
  • 14 Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
  • 15 Department of Neurosurgery, University Hospital of Larissa and University of Thessaly, Larissa, Greece
  • 16 Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  • 17 Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
  • 18 Department of Neurosurgery, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
  • 19 Department of Neurosurgery, Christian Medical College, Vellore, India
  • 20 Department of Neurosurgery, North West General Hospital and Research Center, Peshawar, Pakistan
  • 21 Department of Neurosurgery, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
  • 22 Department of Neurosurgery, Beijing Tiantan Medical Hospital, Capital Medical University, Beijing, China
  • 23 Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
  • 24 Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
  • 25 Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
  • 26 Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Torino, Torino, Italy
  • 27 Division of Anaesthesia, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
  • 28 Oakland University William Beaumont School of Medicine and Michigan Head & Spine Institute, Auburn Hills, MI, USA
  • 29 Departments of Neurology, Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, USA
  • 30 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  • 31 Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
  • 32 Department of Neurosurgery, Alfred Hospital, Melbourne, Australia
  • 33 George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  • 34 INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
  • 35 Department of Neurosurgery, Muhimbili Orthopedic-Neurosurgical Institute, Dar es Salaam, Tanzania
  • 36 Department of Physiopathology and Transplantation, Milan University, Milan, Italy
  • 37 Department of Neurological Surgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA
  • 38 Department of Neurosurgery, The Royal London Hospital, London, UK
  • 39 Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
  • 40 Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
  • 41 Neurosurgery Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 42 Department of Neurosurgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
  • 43 Imperial Neurotrauma Centre, Department of Surgery and Cancer, Imperial College, London, UK
  • 44 Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
Acta Neurochir (Wien), 2019 Jul;161(7):1261-1274.
PMID: 31134383 DOI: 10.1007/s00701-019-03936-y

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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