Background: Decompressive craniectomy (DC) is considered the gold standard blanket surgical procedure for all medically intractable cerebral oedema in Traumatic Brain Injury (TBI). It's only proven fact is that it reduces Intra Cerebral Pressure (ICP) by providing space for the oedematous brain. Attempts are being made to find additional or alternative procedures to improve outcomes in TBI. Basal Cisternostomy is one such technique proposed to bring such a change in world literature.
Aim: To analyse the validity of Basal Cisternostomy in TBI patients.
Materials And Methods: A total of 40 patients who underwent Basal Cisternostomy (BC) in TBI admitted in the senior author's unit between January 2016 and April 2019 were analysed retrospectively. All surgeries were performed by single surgeon with microsurgical expertise. Outcome was assessed according to Glasgow outcome scale (GOS). Results were analysed using SPSS software.
Results: In severe TBI, Basal Cisternostomy group showed 77.8% favourable outcome while Decompressive Craniectomy in addition to Basal Cisternostomy group showed 72.7% only. While favourable GOS was seen in 82% (33/40), the unfavourable outcome was noticed in 12.5% (5/40) and death in 5% (2/40) in this series. Hydrocephalus was seen in 12.5% (5/40). Patients operated earlier from the time of injury showed better results than those who got operated later irrespective of severity of neurological status. ICU stay and hospital stay duration and its validity could not be assessed.
Conclusion: Basal Cisternostomy is an effective procedure in Traumatic Brain Injury patients that not only improves outcome but also reduces the need for Decompressive Craniectomy as a blanket procedure and thus avoiding its associated complications.
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The basal cisternostomy for management of severe traumatic brain injury: A retrospective study.
Chin J Traumatol
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Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China. Electronic address:
Article Synopsis
- Traumatic brain injury (TBI) is a major global health issue, often treated with decompressive craniectomy, but basal cisternostomy has proven to be an effective alternative.
- A study involving 41 patients compared outcomes of decompressive craniectomy and basal cisternostomy for severe TBI, recording various postoperative indicators and the Glasgow outcome scale at 6 months.
- Results showed that patients who underwent decompressive craniectomy had better postoperative intracranial pressure and Glasgow outcome scores compared to those who underwent basal cisternostomy.
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Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.
Decompressive craniectomy (DC) has been the main surgical treatment of refractory high intracranial pressure (ICP) in traumatic brain injury (TBI) for decades. Basal cisternostomy emerged as a novel option in brain trauma, with results still unclear. We performed a systematic review and meta-analysis comparing cisternostomy added to conventional DC versus DC alone for the treatment of TBI.
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