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Return to Driving after a Craniotomy: A Systematic Review and Evidence-Based Approach

Published online by Cambridge University Press:  24 October 2025

David Bergeron Open the ORCID record for David Bergeron [Opens in a new window] ,
Davaine Joel Ndongo Sonfack Open the ORCID record for Davaine Joel Ndongo Sonfack [Opens in a new window] ,
Rana Moshref ,
Michael Anthony Rizzuto Open the ORCID record for Michael Anthony Rizzuto [Opens in a new window] ,
Mark Alexander MacLean Open the ORCID record for Mark Alexander MacLean [Opens in a new window] ,
Simon Walling  and
Sean Christie
David Bergeron*
Affiliation:
Division of Neurosurgery, University of Montreal, Quebec, QC, Canada
Davaine Joel Ndongo Sonfack
Affiliation:
Faculty of Medicine, Laval University, Québec, QC, Canada
Rana Moshref
Affiliation:
Department of Neurosurgery, Western University, London, ON, Canada
Michael Anthony Rizzuto
Affiliation:
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
Mark Alexander MacLean
Affiliation:
Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
Simon Walling
Affiliation:
Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
Sean Christie
Affiliation:
Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
*
Corresponding author: David Bergeron; Email: david.bergeron.1@umontreal.ca
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Abstract

Background:

Patients undergoing craniotomy experience a higher risk of seizures in the ensuing months. Consensus is lacking regarding the appropriate timeframe for safe return to driving following craniotomy in patients not otherwise limited by neurological deficits or a history of epilepsy.

Methods:

We performed a systematic literature review on driving recommendations post-craniotomy. We then performed a scoping review on the risk of seizure post-craniotomy and used risk calculations and accepted risk thresholds from the epilepsy literature to develop an evidence-based approach to driving recommendations post-craniotomy.

Results:

The systematic review of driving recommendations revealed national guidelines (the United Kingdom, New Zealand, Australia). We transposed risk calculations and accepted risk thresholds from the epilepsy literature (accident risk ratio [ARR] < 2; chance of occurrence of a seizure in the next year < 20%) to patients who undergo a craniotomy. Using data from a large meta-analysis of seizure risk post-craniotomy, we calculated ARRs for various underlying pathologies at different postoperative timepoints and compared them with accepted risk thresholds from the epilepsy literature. We determine that patients who undergo a craniotomy for a higher-risk condition (like high-grade glioma) may resume driving after at least 1 month without seizure, whereas those patients undergoing a craniotomy for lower-risk conditions (like infratentorial pathology) may resume driving without consideration for the risk of seizure.

Conclusion:

This systematic review of the literature and evidence-based approach to risk threshold calculations derived from the epilepsy literature provides a preliminary framework to guide clinicians regarding recommendations for return to driving following craniotomy.

Résumé

RÉSUMÉ

Reprise de la conduite automobile après une craniotomie : résultats d’une revue a systématique et approche fondée sur des données probantes

Contexte :

Les patients qui subissent une craniotomie connaissent un risque accru d’épilepsie au cours des mois suivant l’opération. La question du délai le plus approprié avant la reprise de la conduite automobile après une craniotomie chez les personnes qui, par ailleurs, ne souffrent pas de déficit neurologique ou qui n’ont pas d’antécédents d’épilepsie ne fait pas encore l’objet de consensus.

Méthode :

L’équipe de recherche a tout d’abord procédé à un examen systématique de la documentation sur les recommandations relatives à la conduite automobile après une craniotomie. Elle a ensuite fait une revue exploratoire des connaissances sur le risque d’épilepsie consécutif à une craniotomie, employé les calculs de risque et accepté les seuils de risque tirés de la documentation sur l’épilepsie afin d’élaborer une approche fondée sur des données probantes en vue de formuler des recommandations sur la conduite automobile après une craniotomie.

Résultats :

Trois ensembles de directives nationales (Royaume-Uni, Nouvelle-Zélande, Australie) se sont dégagés de la revue systématique des recommandations sur la conduite automobile. L’équipe a ensuite transposé les calculs de risque et accepté les seuils de risque tirés de la documentation sur l’épilepsie (rapport de risques d’accident : < 2; risque de survenue d’une crise d’épilepsie au cours de l’année suivante : < 20 %), appliqués aux patients ayant subi une craniotomie. Les auteurs ont par la suite calculé les rapports de risques d’accident pour diverses affections sous-jacentes, à différents moments après l’opération, à l’aide de données provenant d’une grande méta-analyse sur le risque d’épilepsie après une craniotomie, puis comparé les résultats avec les seuils de risque acceptés, puisés dans la documentation sur l’épilepsie. Aussi l’équipe a-t-elle déterminé, d’une part, que les patients ayant subi une craniotomie pour des affections associées à des risques élevés (p. ex. un gliome de degré élevé de malignité) pouvaient conduire de nouveau après avoir passé au moins 1 mois sans connaître de crise d’épilepsie et, d’autre part, que les patients ayant subi une craniotomie pour des affections associées à des risques faibles (p. ex. une affection sous-tentorielle) pouvaient reprendre la conduite automobile sans égard au risque d’épilepsie.

Conclusion :

Les résultats de la revue systématique de la documentation et l’approche fondée sur des données probantes quant aux calculs des seuils de risque provenant de la documentation sur l’épilepsie fournissent aux médecins un cadre préliminaire de recommandations sur la reprise de la conduite automobile après une craniotomie.

Keywords

automobile drivingcraniotomydriving guidelinesneurosurgeryseizures

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 8
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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Footnotes

David Bergeron and Davaine Joel Ndongo Sonfack contributed equally (co-first authors).

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