Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2022; 19(02): 078-083
DOI: 10.1055/s-0041-1739478
Review Article

Outcomes and Predictors of Outcome with Cisternostomy in the Management of Traumatic Brain Injury—A Prospective Observational Study at a Tertiary Centre

Ramesh Chandra Vemula
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
,
BCM Prasad
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
,
Hanuma Naik Banavath
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
,
Pavan Kumar G Kale
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
,
Mohana Murali Krishna N
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
,
Sreeram Gokanapudi
1   Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality in young individuals. Goal of management in TBI patients is mainly focused on the secondary injury. Since the cisterns and the brain communicate, it would be possible to decrease the pressure in both these compartments by opening the cisterns to the atmospheric pressure.

Objective To study the outcomes and predictors of outcome with cisternostomy in the management of TBI.

Methods A single tertiary care center's prospective observational study of outcomes with cisternostomy with intraoperative intracranial pressure (ICP) monitoring. Patients were evaluated clinically and radiologically with Marshall CT score. They were categorized into mild, moderate, and severe head injury groups based on Glasgow coma scale (GCS) score. Outcomes were evaluated with Glasgow outcome scale (GOS) score.

Results A total of 25 patients with TBI were enrolled in this study. They underwent cisternostomy with intraoperative ICP monitoring. They were categorized into 4 groups based on the age. In our study, mortality rate was 32%. As much as 48% had good recovery at 3 months follow-up with GOS 4 and 5. Mean ICP after cisternostomy was 6.36 ± 1.91 mm Hg. In our study, there was decrease in ICP after cisternostomy.

Conclusion Age, time interval from trauma to surgery, and ICP showed prognostic importance on outcomes. Cisternostomy can efficiently decrease the ICP in the TBI patients and reduce postoperative complications.

Keywords

Cisternostomy - head injury - recent advances in neurotrauma - surgery for neurotrauma - traumatic brain injury


Publication History

Article published online:
12 September 2022

© 2022. Neurotrauma Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil 2010; 25 (02) 72-80
    CrossrefPubMedSearch in Google Scholar
  • 2 Graham DI, Ford I, Adams JH. et al. Ischaemic brain damage is still common in fatal non-missile head injury. J Neurol Neurosurg Psychiatry 1989; 52 (03) 346-350
    CrossrefPubMedSearch in Google Scholar
  • 3 Rahmanian A, Haghnegahdar A, Rahmanian A, Ghaffarpasand F. Effects of intracranial pressure monitoring on outcome of patients with severe traumatic brain injury; results of a historical cohort study. Bull Emerg Trauma 2014; 2 (04) 151-155
    PubMedSearch in Google Scholar
  • 4 Alvis-Miranda H, Castellar-Leones SM, Moscote-Salazar LR. Decompressive craniectomy and traumatic brain injury: a review. Bull Emerg Trauma 2013; 1 (02) 60-68
    PubMedSearch in Google Scholar
  • 5 Ho B, Ooi M, Yinn C. et al. Complications of decompressive craniectomy. JHN Journal 2012; 7 (01) 4
    PubMedSearch in Google Scholar
  • 6 Yang L, Kress BT, Weber HJ. et al. Evaluating glymphatic pathway function utilizing clinically relevant intrathecal infusion of CSF tracer. J Transl Med 2013; 11: 107
    CrossrefPubMedSearch in Google Scholar
  • 7 Mura J, Figueiredo EG, Carmona P, Palma-Fellemberg Á, de Faria JW. The anterior ventriculo-cisternostomy: the pioneers' work revisited. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (03) 146-151
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Cherian I, Yi G, Munakomi S. Cisternostomy: replacing the age old decompressive hemicraniectomy?. Asian J Neurosurg 2013; 8 (03) 132-138
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Cherian I, Grasso G, Bernardo A, Munakomi S. Anatomy and physiology of cisternostomy. Chin J Traumatol 2016; 19 (01) 7-10
    CrossrefPubMedSearch in Google Scholar
  • 10 Goyal N, Kumar P, Chaturvedi J, Siddiqui S, Agrawal D. Basal cisternostomy in severe head injury: An idea whose time has come?. Indian J Neurotrauma 2020; 17: 3-5
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Parthiban JKBC, Sundaramahalingam S, Rao JB. et al. Basal cisternostomy - A Microsurgical cerebro spinal fluid let out procedure and treatment option in the management of traumatic brain injury. Analysis of 40 consecutive head injury patients operated with and without bone flap replacement following cisternostomy in a tertiary care centre in India. Neurol India 2021; 69 (02) 328-333
    CrossrefPubMedSearch in Google Scholar
  • 12 Cherian I, Burhan H. Outcomes of severe head injury patients undergoing cisternostomy at tertiary care hospital in Nepal. Indonesian Journal of Neurosurgery 2019; 2 (03) 55-59
    PubMedSearch in Google Scholar
  • 13 Youssef O, Ali TM, Anbar K. et al. Value of adding cisternostomy to decompressive hemicraniectomy in the management of traumatic acute subdural hematoma patients. Open Access Maced J Med Sci 2020; 8 (B) 1014-1022
    CrossrefPubMedSearch in Google Scholar
  • 14 Ono J, Yamaura A, Kubota M, Okimura Y, Isobe K. Outcome prediction in severe head injury: analyses of clinical prognostic factors. J Clin Neurosci 2001; 8 (02) 120-123
    CrossrefPubMedSearch in Google Scholar
  • 15 Goyal N, Kumar P. Putting ‘CSF-shift edema’ hypothesis to test: comparing cisternal and parenchymal pressures after basal cisternostomy for head injury. World Neurosurg 2021; 148: e252-e263
    CrossrefPubMedSearch in Google Scholar
  • 16 Giammattei L, Starnoni D, Maduri R. et al. Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma. Acta Neurochir (Wien) 2020; 162 (03) 469-479
    CrossrefPubMedSearch in Google Scholar
  • 17 Mendelow AD, Gregson BA, Rowan EN. et al; STITCH(Trauma) Investigators. Early surgery versus initial conservative treatment in patients with traumatic intracerebral haemorrhage [STITCH(Trauma)]: the first randomised trial. J Neurotrauma 2015; 32 (17) 1312-1323
    CrossrefPubMedSearch in Google Scholar
  • 18 Chandra PS. Basal Cisternostomy: Hype or Hope?. Neurol India 2021; 69 (02) 243-244
    CrossrefPubMedSearch in Google Scholar