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, Angelos G. Kolias, Tamara Tajsic, Amos Adeleye, Abenezer Tirsit Aklilu, Tedy Apriawan, Abdul Hafid Bajamal, Ernest J. Barthélemy, B. Indira Devi, Dhananjaya Bhat, Diederik Bulters, Randall Chesnut, Giuseppe Citerio, D. Jamie Cooper, Marek Czosnyka, Idara Edem, Nasser M.F. El-Ghandour, Anthony Figaji, Kostas N. Fountas, Clare GallagherGregory W.J. Hawryluk, Corrado Iaccarino, Mathew Joseph, Tariq Khan, Tsegazeab Laeke, Oleg Levchenko, Baiyun Liu, Weiming Liu, Andrew Maas, Geoffrey T. Manley, Paul Manson, Anna T. Mazzeo, David K. Menon, Daniel B. Michael, Susanne Muehlschlegel, David O. Okonkwo, Kee B. Park, Jeffrey V. Rosenfeld, Gail Rosseau, Andres M. Rubiano, Hamisi K. Shabani, Nino Stocchetti, Shelly D. Timmons, Ivan Timofeev, Chris Uff, Jamie S. Ullman, Alex Valadka, Vicknes Waran, Adam Wells, Mark H. Wilson, Franco Servadei

Research output: Contribution to journalReview ArticleOtherpeer-review

35 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1261-1274
Number of pages14
JournalActa Neurochirurgica
Issue number7
Publication statusPublished - 1 Jul 2019


  • Cranioplasty
  • Decompression
  • Neurosurgery
  • Neurotrauma

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