Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

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Chylothorax is a rare form of chyle accumulation that can be associated with both traumatic and non-traumatic causes. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a left-sided chylothorax as a late complication to his thoracic spine trauma. A 19-year-old multi-trauma patient with bilateral pneumothorax, bilateral lung contusions and a severe thoracic spine fracture-dislocation was admitted to the intensive care unit (ICU) of our hospital intubated due to his unstable respiratory function. Bilateral thoracostomies were placed to his thoracic cavity prior to his admission to the ICU. The thoracic fracture-dislocation was stabilized with posterior fixation of his thoracic spine during his stay at the ICU. He was transferred to the neurosurgery department where at the 50th day of his hospitalization, a left-sided chylothorax was identified. Conservative management was decided and the chyle leak ceased over a period of 2 weeks. The patient was discharged from the clinic after a 3-month period of hospitalization. Traumatic chylothorax is a rare complication directly linked to thoracic spine fractures. It can occur immediately after trauma or several weeks after as in our case. Early diagnosis and treatment are essential for the avoidance of severe complications linked to the chyle loss.

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