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David S. Hersh, Jonathan E. Martin, Ruth E. Bristol, Samuel R. Browd, Gerald Grant, Nalin Gupta, Todd C. Hankinson, Eric M. Jackson, John R. W. Kestle, Mark D. Krieger, Abhaya V. Kulkarni, Casey J. Madura, Jonathan Pindrik, Ian F. Pollack, Jeffrey S. Raskin, Jay Riva-Cambrin, Curtis J. Rozzelle, Jodi L. Smith, and John C. Wellons III

surveillance practice patterns and the dearth of supporting literature, the Delphi method was proposed to identify areas of consensus and opportunities for further research. The Delphi technique uses a structured series of anonymous questionnaires to build consensus among a group of topic experts. In particular, the modified Delphi method, which culminates in a face-to-face meeting to facilitate open discussion and modification of the consensus statements, has been successfully used to address a range of pediatric neurosurgical topics, including pediatric cervical spine

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Philipp Dammann, Adib A. Abla, Rustam Al-Shahi Salman, Hugo Andrade-Barazarte, Vladimir Benes, Marco Cenzato, E. Sander Connolly Jr., Jan F. Cornelius, William T. Couldwell, Rafael G. Sola, Santiago Gomez-Paz, Erik Hauck, Juha Hernesniemi, Juri Kivelev, Giuseppe Lanzino, R. Loch Macdonald, Jacques J. Morcos, Christopher S. Ogilvy, Hans-Jakob Steiger, Gary K. Steinberg, Alejandro N. Santos, Laurèl Rauschenbach, Marvin Darkwah Oppong, Börge Schmidt, Robert F. Spetzler, Karl Schaller, Michael T. Lawton, and Ulrich Sure

13 ), while an indication for resection after a single disabling SH is seen as more controversial (class IIb evidence, level C 13 ). Clinical decision-making and selection for BSCM surgery requires considering more variables than merely the history and frequency of SHs. Therefore, we sought to perform a survey using the Delphi method on multiple aspects of surgical treatment and management of BSCM among international experts to investigate the extent of current clinical consensus that could be achieved and identify questions and ambiguities that may drive future

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Sepideh Amin-Hanjani, Howard A. Riina, and Fred G. Barker II

I n this issue, Dammann et al. 1 offer the results of a conscientiously designed and clearly reported “Delphi method survey” study that addresses various surgical aspects of brainstem cavernous malformation (CM) management. The rarity of brainstem CMs means that prospective clinical data are scarce in any form; this paper offers a snapshot of current expert opinion on the topic, organized in a series of specific clinical questions. What is a Delphi study, and how does it fit within the accepted framework of neurosurgical knowledge development and

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Nikita G. Alexiades, Belinda Shao, Bruno P. Braga, Christopher M. Bonfield, Douglas L. Brockmeyer, Samuel R. Browd, Michael DiLuna, Mari L. Groves, Todd C. Hankinson, Andrew Jea, Jeffrey R. Leonard, Sean M. Lew, David D. Limbrick Jr., Francesco T. Mangano, Jonathan Martin, Joshua Pahys, Alexander Powers, Mark R. Proctor, Luis Rodriguez, Curtis Rozzelle, Phillip B. Storm, and Richard C. E. Anderson

, skull fracture, and intracranial abscess formation, along with focal and general neurological worsening while in traction, have all been addressed in the adult literature, but few recommendations exist to guide practice. 5 , 14 , 20–22 The paucity of empirical evidence surrounding many of these topics prompted use of the Delphi method to try to build consensus among a multidisciplinary group of experienced pediatric spine surgeons. The Delphi method has been adopted by many medical subspecialties to enable the development of best-practice guidelines and statements

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Nikita G. Alexiades, Edward S. Ahn, Jeffrey P. Blount, Douglas L. Brockmeyer, Samuel R. Browd, Gerald A. Grant, Gregory G. Heuer, Todd C. Hankinson, Bermans J. Iskandar, Andrew Jea, Mark D. Krieger, Jeffrey R. Leonard, David D. Limbrick Jr., Cormac O. Maher, Mark R. Proctor, David I. Sandberg, John C. Wellons III, Belinda Shao, Neil A. Feldstein, and Richard C. E. Anderson

leaks following complex tethered cord release, we first conducted a systematic literature review of existing evidence for a series of pre-, intra-, and postoperative preventative strategies. Given the lack of sufficient empirical evidence available, we used the Delphi method of building consensus among a group of experienced pediatric neurosurgeons to frame best practice statements. Originally developed in the 1960s by the Rand Corporation, the Delphi method is a technique to build consensus around expert opinions using a structured process of repeated anonymous

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Praveen V. Mummaneni, John F. Burke, Andrew K. Chan, Julie Ann Sosa, Errol P. Lobo, Valli P. Mummaneni, Sheila Antrum, Sigurd H. Berven, Michael S. Conte, Sarah B. Doernberg, Andrew N. Goldberg, Christopher P. Hess, Steven W. Hetts, S. Andrew Josephson, Maureen P. Kohi, C. Benjamin Ma, Vaikom S. Mahadevan, Annette M. Molinaro, Andrew H. Murr, Sirisha Narayana, John P. Roberts, Marshall L. Stoller, Philip V. Theodosopoulos, Thomas P. Vail, Sandra Wienholz, Michael A. Gropper, Adrienne Green, and Mitchel S. Berger

ventilators. Furthermore, guidance is needed to minimize nosocomial transmission of COVID-19 to patients and staff during invasive procedures. 13 There is insufficient data and time in the midst of a pandemic to create evidence-based guidelines for triaging invasive procedures. 14 Thus, we present our institutional experience using a modified Delphi method. In brief, the Delphi method consists of first forming an expert panel, creating a series of statements that are submitted to the panel, obtaining anonymous feedback from the panel, amending the statements, and iterating

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Christopher P. Ames, Justin S. Smith, Robert Eastlack, Donald J. Blaskiewicz, Christopher I. Shaffrey, Frank Schwab, Shay Bess, Han Jo Kim, Gregory M. Mundis Jr., Eric Klineberg, Munish Gupta, Michael O’Brien, Richard Hostin, Justin K. Scheer, Themistocles S. Protopsaltis, Kai-Ming G. Fu, Robert Hart, Todd J. Albert, K. Daniel Riew, Michael G. Fehlings, Vedat Deviren, Virginie Lafage, and International Spine Study Group

thoracolumbar deformity. This process began using a modified Delphi approach in which established surgeons in the field of thoracolumbar deformity surgery created a classification framework based primarily on expert opinion and available literature. The classification evolved through an iterative process as the literature matured with regard to the most clinically impactful radiographic parameters. 3 , 15 , 32 , 38–41 , 43 Ultimately, this process culminated in the merging of efforts of the Scoliosis Research Society (SRS) and of Schwab and colleagues to produce a widely

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Jacob K. Greenberg, Stephen Shelby Burks, Christopher F. Dibble, Saad Javeed, Vivek P. Gupta, Alexander T. Yahanda, Roberto J. Perez-Roman, Vaidya Govindarajan, Andrew T. Dailey, Sanjay Dhall, Daniel J. Hoh, Daniel E. Gelb, Adam S. Kanter, Eric O. Klineberg, Michael J. Lee, Praveen V. Mummaneni, Paul Park, Charles A. Sansur, Khoi D. Than, Jon J. W. Yoon, Michael Y. Wang, and Wilson Z. Ray

, decompression, and arthrodesis; or “other” recommendations. Although posterior approaches for MIS arthrodesis vary, we generally perform this technique by inserting a guide tube down each stab incision, decorticating the facet joint, and placing allograft prior to pedicle screw placement ( Appendix and E-Fig. 1 ). When necessary, we use a similar tubular approach to perform posterior MIS decompressions. Algorithm Development We used a stepwise approach that incorporated a modified Delphi technique to develop the updated treatment algorithm. 16 First, we conducted a

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Jacob K. Greenberg, Stephen Shelby Burks, Christopher F. Dibble, Saad Javeed, Vivek P. Gupta, Alexander T. Yahanda, Roberto J. Perez-Roman, Vaidya Govindarajan, Andrew T. Dailey, Sanjay Dhall, Daniel J. Hoh, Daniel E. Gelb, Adam S. Kanter, Eric O. Klineberg, Michael J. Lee, Praveen V. Mummaneni, Paul Park, Charles A. Sansur, Khoi D. Than, Jon J. W. Yoon, Michael Y. Wang, and Wilson Z. Ray

, decompression, and arthrodesis; or “other” recommendations. Although posterior approaches for MIS arthrodesis vary, we generally perform this technique by inserting a guide tube down each stab incision, decorticating the facet joint, and placing allograft prior to pedicle screw placement ( Appendix and E-Fig. 1 ). When necessary, we use a similar tubular approach to perform posterior MIS decompressions. Algorithm Development We used a stepwise approach that incorporated a modified Delphi technique to develop the updated treatment algorithm. 16 First, we conducted a

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Aziz S. Alali, Nancy Temkin, Jason Barber, Jim Pridgeon, Kelley Chaddock, Sureyya Dikmen, Peter Hendrickson, Walter Videtta, Silvia Lujan, Gustavo Petroni, Nahuel Guadagnoli, Zulma Urbina, and Randall M. Chesnut

arose via a Delphi-based consensus development process. 10 The consensus group involved 43 neurosurgeons and intensivists who have extensive experience managing patients with severe TBI based on clinical examination and CT findings alone without ICP monitoring. They proposed a set of predictors, based on CT and clinical findings at baseline after resuscitation, to identify those patients for whom they would recommend initiating treatment for suspected intracranial hypertension under conditions without ICP monitoring. This process was part of an NIH clinical research