Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight

Scott L. Zuckerman; Aaron M. Yengo-Kahn; Alan R. Tang; Julian E. Bailes; Kathryn Beauchamp; Mitchel S. Berger; Christopher M. Bonfield; Paul J. Camarata; Robert C. Cantu; Gavin A. Davis; Richard G. Ellenbogen; Michael J. Ellis; Hank Feuer; Eric Guazzo; Odette A. Harris; Peter Heppner; Stephen Honeybul; Geoff Manley; Joseph C. Maroon; Vincent J. Miele; Brian V. Nahed; David O. Okonkwo; Mark E. Oppenlander; Jerry Petty; H. Ian Sabin; Uzma Samadani; Eric W. Sherburn; Mark Sheridan; Charles H. Tator; Nicholas Theodore; Shelly D. Timmons; Graeme F. Woodworth; Gary S. Solomon; Allen K. Sills

doi:10.1093/neuros/nyab041

Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight

Scott L. Zuckerman, Aaron M. Yengo-Kahn, Alan R. Tang, Julian E. Bailes, Kathryn Beauchamp, Mitchel S. Berger, Christopher M. Bonfield, Paul J. Camarata, Robert C. Cantu, Gavin A. Davis, Richard G. Ellenbogen, Michael J. Ellis, Hank Feuer, Eric Guazzo, Odette A. Harris, Peter Heppner, Stephen Honeybul, Geoff Manley, Joseph C. Maroon, Vincent J. MieleBrian V. Nahed, David O. Okonkwo, Mark E. Oppenlander, Jerry Petty, H. Ian Sabin, Uzma Samadani, Eric W. Sherburn, Mark Sheridan, Charles H. Tator, Nicholas Theodore, Shelly D. Timmons, Graeme F. Woodworth, Gary S. Solomon, Allen K. Sills

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: 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. OBJECTIVE: To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Original language	English (US)
Pages (from-to)	E495-E504
Journal	Neurosurgery
Volume	88
Issue number	6
DOIs	https://doi.org/10.1093/neuros/nyab041
State	Published - Jun 1 2021

Keywords

Collision sports
Epidural hemorrhage
Football
Return to play
Sports
Subdural hemorrhage
Traumatic brain injury

ASJC Scopus subject areas

Clinical Neurology
Surgery

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10.1093/neuros/nyab041

Cite this

Zuckerman, S. L., Yengo-Kahn, A. M., Tang, A. R., Bailes, J. E., Beauchamp, K., Berger, M. S., Bonfield, C. M., Camarata, P. J., Cantu, R. C., Davis, G. A., Ellenbogen, R. G., Ellis, M. J., Feuer, H., Guazzo, E., Harris, O. A., Heppner, P., Honeybul, S., Manley, G., Maroon, J. C., ... Sills, A. K. (2021). Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight. Neurosurgery, 88(6), E495-E504. https://doi.org/10.1093/neuros/nyab041

Zuckerman, SL, Yengo-Kahn, AM, Tang, AR, Bailes, JE, Beauchamp, K, Berger, MS, Bonfield, CM, Camarata, PJ, Cantu, RC, Davis, GA, Ellenbogen, RG, Ellis, MJ, Feuer, H, Guazzo, E, Harris, OA, Heppner, P, Honeybul, S, Manley, G, Maroon, JC, Miele, VJ, Nahed, BV, Okonkwo, DO, Oppenlander, ME, Petty, J, Sabin, HI, Samadani, U, Sherburn, EW, Sheridan, M, Tator, CH, Theodore, N, Timmons, SD, Woodworth, GF, Solomon, GS & Sills, AK 2021, 'Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight', Neurosurgery, vol. 88, no. 6, pp. E495-E504. https://doi.org/10.1093/neuros/nyab041

@article{40d97519a6b244e9a40b70781448928c,

title = "Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight",

abstract = "BACKGROUND: 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. OBJECTIVE: To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS: 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. RESULTS: 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). CONCLUSION: 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.",

keywords = "Collision sports, Epidural hemorrhage, Football, Return to play, Sports, Subdural hemorrhage, Traumatic brain injury",

author = "Zuckerman, {Scott L.} and Yengo-Kahn, {Aaron M.} and Tang, {Alan R.} and Bailes, {Julian E.} and Kathryn Beauchamp and Berger, {Mitchel S.} and Bonfield, {Christopher M.} and Camarata, {Paul J.} and Cantu, {Robert C.} and Davis, {Gavin A.} and Ellenbogen, {Richard G.} and Ellis, {Michael J.} and Hank Feuer and Eric Guazzo and Harris, {Odette A.} and Peter Heppner and Stephen Honeybul and Geoff Manley and Maroon, {Joseph C.} and Miele, {Vincent J.} and Nahed, {Brian V.} and Okonkwo, {David O.} and Oppenlander, {Mark E.} and Jerry Petty and Sabin, {H. Ian} and Uzma Samadani and Sherburn, {Eric W.} and Mark Sheridan and Tator, {Charles H.} and Nicholas Theodore and Timmons, {Shelly D.} and Woodworth, {Graeme F.} and Solomon, {Gary S.} and Sills, {Allen K.}",

note = "Publisher Copyright: {\textcopyright} 2021 Congress of Neurological Surgeons 2021.",

year = "2021",

month = jun,

day = "1",

doi = "10.1093/neuros/nyab041",

language = "English (US)",

volume = "88",

pages = "E495--E504",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

TY - JOUR

T1 - Sport-Related Structural Brain Injury and Return to Play

T2 - Systematic Review and Expert Insight

AU - Zuckerman, Scott L.

AU - Yengo-Kahn, Aaron M.

AU - Tang, Alan R.

AU - Bailes, Julian E.

AU - Beauchamp, Kathryn

AU - Berger, Mitchel S.

AU - Bonfield, Christopher M.

AU - Camarata, Paul J.

AU - Cantu, Robert C.

AU - Davis, Gavin A.

AU - Ellenbogen, Richard G.

AU - Ellis, Michael J.

AU - Feuer, Hank

AU - Guazzo, Eric

AU - Harris, Odette A.

AU - Heppner, Peter

AU - Honeybul, Stephen

AU - Manley, Geoff

AU - Maroon, Joseph C.

AU - Miele, Vincent J.

AU - Nahed, Brian V.

AU - Okonkwo, David O.

AU - Oppenlander, Mark E.

AU - Petty, Jerry

AU - Sabin, H. Ian

AU - Samadani, Uzma

AU - Sherburn, Eric W.

AU - Sheridan, Mark

AU - Tator, Charles H.

AU - Theodore, Nicholas

AU - Timmons, Shelly D.

AU - Woodworth, Graeme F.

AU - Solomon, Gary S.

AU - Sills, Allen K.

PY - 2021/6/1

Y1 - 2021/6/1

N2 - BACKGROUND: 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. OBJECTIVE: To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

AB - BACKGROUND: 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. OBJECTIVE: To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

KW - Collision sports

KW - Epidural hemorrhage

KW - Football

KW - Return to play

KW - Sports

KW - Subdural hemorrhage

KW - Traumatic brain injury

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UR - http://www.scopus.com/inward/citedby.url?scp=85106543240&partnerID=8YFLogxK

U2 - 10.1093/neuros/nyab041

DO - 10.1093/neuros/nyab041

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AN - SCOPUS:85106543240

SN - 0148-396X

VL - 88

SP - E495-E504

JO - Neurosurgery

JF - Neurosurgery

IS - 6

ER -

Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight

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