Participation in Contact or Collision Sports in Athletes
Despite a plethora of guidelines for return to play following mild head injury, a discussion of when and if an athlete should be allowed to participate in contact or collision sports if he or she sustains a structural brain lesion or after a head injury requiring craniotomy is lacking. The structural lesions discussed include arachnoid cyst, Chiari malformation Type I, cavum septum pellucidum, and the presence of ventriculoperitoneal shunts. Issues unique to this population with respect to the possibility of increased risk of head injury are addressed. The population of athletes with epilepsy and certain genetic risk factors is also discussed. Finally, the ability of athletes to participate in contact or collision sports after undergoing craniotomies for traumatic or congenital abnormalities is evaluated. Several known in stances of athletes returning to contact sports following craniotomy are also reviewed.

Approximately 20% of the 1.54 million head in juries that are estimated to occur in the US each year are sports related. Advances in diagnosis and management over the past decade have resulted in a plethora of guidelines for return to play after mild head injury. Although these systems address in detail the treatment of an athlete after concussion, discussion of when and if an athlete should be allowed to participate in contact or collision sports following discovery of a structural brain lesion or after a head injury requiring craniotomy is lacking.

In this article we address participation issues in athletes with structural brain lesions or with a history of craniotomy. The structural lesions we discuss include arachnoid cyst, CM-I, cavum septum pellucidum, and the presence of a VP shunt. Issues unique to this population with respect to the possibility of increased risk of head injury are addressed. The athletic population with epilepsy and certain genetic risk factors is also discussed. Finally, the ability of athletes to participate in contact or collision sports after undergoing craniotomies for traumatic or congenital abnormalities is evaluated. There are several known instances of athletes returning to contact sports postcraniotomy, and these cases are reviewed.