Microsurgical Cisternostomy for Treating Critical Patients with Traumatic Brain Injury - An alternative Therapeutic Approach

• Published in: Arquivos brasileiros de neurocirurgia Vol. 39; no. 3; pp. 155 - 160
• Main Authors: Campos Paiva, Aline Lariessy, Vitorino Araujo, João Luiz, Lovato, Renan Maximilian, Veiga, José Carlos Esteves
• Format: Journal Article
• Language: English
• Published: Rio de Janeiro, Brazil Thieme Revinter Publicações Ltda 01-09-2020
• Subjects: cisternostomy; decompressive craniectomy; hydrodynamics; Original Article | Artigo Original; traumatic brain injury; cisternostomy; cisternostomia; craniectomia descompressiva; traumatic brain injury; traumatismo cranioencefalico; hidrodinâmica; hydrodynamics; decompressive craniectomy
• ISSN: 0103-5355; 2359-5922
• DOI: 10.1055/s-0040-1701279

Abstract
Introduction
 Traumatic brain injury (TBI) is a major cause of mortality around the world. Few advances regarding surgical approaches have been made in the past few years to improve its outcomes. Microsurgical cisternostomy is a well-established technique used in vascular and skull base surgery and recently emerges as a suitable procedure with lesser costs and morbidity when compared with decompressive craniectomy in patients with diffuse TBI. This study aims to describe the technique, indications, and limitations of cisternostomy and to compare it with decompressive craniectomy (DC).
Methods
 A prospective study is being conducted after obtaining approval of the local human ethics research committee. Once the inclusion and exclusion criteria are applied, the patients are submitted to microsurgical cisternostomy, pre and postoperative neurological status and brain computed tomography (CT) evaluation. A detailed review was also performed, which discusses diffuse TBI, DC, and cisternostomy for the treatment of TBI.
Results
 Two patients were submitted to cisternostomy after TBI and the presence of acute subdural hematoma and huge midline shift at admission computed tomography. The surgery was authorized by the family (the informed consent form was signed). Both patients evolved with a good recovery after the procedure, and had a satisfactory control brain CT. No further surgeries were required after the initial cisternostomy.
Conclusions
 Cisternostomy is an adequate technique for the treatment of selected patients affected by diffuse TBI, and it is a proper alternative to DC with lesser costs and morbidity, since a single neurosurgical procedure is performed. A prospective study is being conducted for a better evaluation and these were the initial cases of this new protocol.