Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Neurosurgery. 2021 May 13;88(6):E495-E504. doi: 10.1093/neuros/nyab041.
Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI.
To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions.
A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted.
Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = -0.58, 95% CI -0.111, -0.005, P = .033).
RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.
运动相关的结构性脑损伤（SRSBI）是在运动过程中发生的颅内病变。其管理与非运动相关的脑损伤相似。目前对于 SRSBI 后的复出（RTP）存在经验上的空白。
通过（1）聚焦于 SRSBI 的系统综述和（2）对 31 位国际神经外科医生的 RTP 调查，为 SRSBI 的手术管理和 RTP 提供关键见解。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 2012 年至今的 SRSBI 进行了系统文献综述，并对 31 位国际神经外科医生进行了 SRSBI 中的 RTP 横断面调查。
在系统综述的 27 篇文章中，有 9 篇（33.0%）病例报告为 12 名运动员提供了 RTP 信息。为了评估专家意见，31 位神经外科医生（96.9%）提供了调查回复。对于急性、无症状的 SRSBI，有 12 位（38.7%）医生不会进行手术。在 19 位（61.3%）会进行手术的医生中，最常见的手术指征是中线移位（63.2%）和出血体积>10mm（52.6%）。对于有或无颅骨钻孔的 SRSBI 后出血已解决的情况，大多数专家（>75%）允许运动员在 6 至 12 个月后重返高接触/碰撞运动。大约 80%的专家不支持有持续出血的运动员重返高接触/碰撞运动。对于 SRSBI 的开颅手术，40%至 50%的专家认为在 6 至 12 个月后可以复出。线性回归显示，专家允许在较高的运动水平上更早复出（β=-0.58，95%CI-0.111，-0.005，P=0.033）。
运动员结构性脑损伤后的 RTP 决策差异很大。虽然个体化的 RTP 决策至关重要，但 31 位国际运动神经外科医生的综合专家意见提供了关键见解。运动水平被发现是 RTP 决定的一个重要考虑因素。
