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A Systematic Review-Informed Guidance for Reporting Outcomes in Cranioplasty Studies (ROCS): The ROCS Statement-A
Marcio Y Ferreira1, Leonardo J C Cardoso2, Luis F Paleare3
1Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY.
The Journal of Craniofacial Surgery
|August 10, 2026
Summary
Cranioplasty research lacks standardized reporting, hindering evidence synthesis. A new guideline, the ROCS Statement, was developed to improve reproducibility and comparability in cranioplasty studies.
Area of Science:
- Neurosurgery and Plastic Surgery
- Evidence-Based Medicine
- Clinical Research Methodology
Background:
- Cranioplasty research has expanded, but methodological rigor and outcome reporting standardization lag.
- Heterogeneity in cranioplasty literature impedes cumulative evidence synthesis.
- A systematic review was conducted to assess reporting practices and propose a guideline.
Purpose of the Study:
- To evaluate reporting practices in the cranioplasty literature.
- To propose a standardized reporting guideline for cranioplasty studies.
- To enhance reproducibility and comparability in cranioplasty research.
Main Methods:
- Systematic literature search following PRISMA guidelines (PubMed, Embase, Cochrane Library).
- Included observational or randomized studies on cranioplasty with >400 patients, published in English within the last 10 years.
- Assessment focused on 7 key domains: patient characteristics, methodology, definitions, procedure, intraoperative, postoperative, and limitations.
Main Results:
- Twenty-nine studies (39,236 patients) were included in the analysis.
- Significant reporting deficiencies were identified across all assessed domains.
- The ROCS (Reporting of Cranioplasty Studies) Statement, comprising 55 items across 7 domains, was developed.
Conclusions:
- Deficiencies in reporting practices were confirmed in the cranioplasty literature.
- Standardized and transparent reporting is crucial for advancing cranioplasty evidence and patient care.
- The ROCS Statement aims to improve reproducibility, comparability, and transparency in future cranioplasty research.
