Cisternostomy for traumatic brain injury—rigorous evaluation is necessary

Servadei, Franco; Kolias, Angelos G.; Kirollos, Ramez; Khan, Tariq; Hutchinson, Peter J.

doi:10.1007/s00701-020-04224-w

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…Recently, Servadei et al [43] warned us about the use of cisternostomy for TBI as a new procedure, but without sufficient evidence to warrant its usage outside of research settings. Neurosurgery and innovation have been closely related since its start.…”

Section: Discussionmentioning

confidence: 99%

The Role of Cisternostomy in the Management of Severe Traumatic Brain Injury: A Triple-Center Study

Encarnación Ramirez,

Baez,

Marszal Mangbel’ Mikorska

et al. 2023

Surgeries

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Background: Traumatic brain injury (TBI) is a critical public health problem worldwide, constituting a major cause of mortality and morbidity for people of all ages, but especially in the younger population. Decompressive craniectomy (DC) and cisternostomy are surgical procedures commonly used in the management of severe TBI, but their effectiveness in improving outcomes remains controversial. Methods: We conducted a prospective longitudinal study on patients who underwent surgical treatment for severe TBI between 2021 and 2022. The extended Glasgow outcome scale (GOS-E) was used to assess clinical outcome at 2 weeks, 3 months, and 6 months after surgery. Results: The study included 30 patients (21 men and 9 women) who met the inclusion criteria. Among them, 24 patients (80%) underwent DC combined with cisternostomy, while 6 patients (20%) underwent cisternostomy alone. The initial Glasgow Coma Scale (GCS) score at admission ranged from 4 to 8 points, with an average score of 5.9. The overall mortality and overall morbidity was 13.3% and 20%, respectively. The mortality rate was 12.5% and 16.7% in the DC + cisternostomy group and in the cisternostomy alone group, respectively. No statistically significant difference was seen between the two groups in terms of mortality, morbidity and favorable outcome at 2 weeks, 3 months and 6 months. Conclusions: Our preliminary multi-center study shows a good clinical outcome in patients who underwent DC + cisternostomy or cisternostomy alone in both early and long-term follow-up. Larger multi-center randomized trials are needed to establish the effectiveness of cisternostomy in the management of TBI.

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Section: Discussionmentioning

confidence: 99%

The Role of Cisternostomy in the Management of Severe Traumatic Brain Injury: A Triple-Center Study

Encarnación Ramirez,

Baez,

Marszal Mangbel’ Mikorska

et al. 2023

Surgeries

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“…Декомпресивна краніектомія (ДК) -це операція, що включає видалення великого кісткового клаптя черепа [15]. Її можна використовувати як первинну процедуру, проведену одночасно з евакуацією внутрішньочерепної гематоми, або як вторинну -з метою зменшення ICP, стійкого до медичного лікування.…”

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“…У даний час є дані 5 опублікованих рандомізованих досліджень ДК при ЧМТ. Зроблені такі висновки [15]: 1) однобічна або біфронтальна ДК, що використовується як терапія останнього рівня для пацієнтів з тяжкою, стійкою і рефрактерною посттравматичною внутрішньочерепною гіпертензією, приводить до значного зниження смертності, але збільшує інвалідність; 2) рання нейропротективна біфронтальна ДК при внутрішньочерепній гіпертензії легкого й середнього ступеня тяжкості не перевершує медикаментозне лікування пацієнтів з ЧМТ; 3) велика лобно-скронево-тім'яна ДК (близько 15 см) перевершує невелику однобічну ДК (близько 8 см) для пацієнтів з однобічним набряком півкулі з великими або маленькими контузіями; 4) невелике пілотне дослідження виявило тенденцію до покращання виживаності й функціональних результатів при бітемпоральній декомпресії порівняно з медикаментозним лікуванням у дітей із посттравматичною внутрішньочерепною гіпертензією [15]. Цистерностомію з приводу тяжкої ЧМТ слід розглядати як новий метод, але не вистачає проспективних рандомізованих контрольованих досліджень, що дозволять з'ясувати, ефективна вона чи ні.…”

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Modern principles of diagnosis and treatment of severe traumatic brain injury

Cherniy

2022

ЕМ

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Traumatic brain injury (TBI) is a heterogeneous syndrome that includes various types of trauma. About 10–15 % of patients have severe TBI, accompanied by high rates of disability and mortality. Currently, the methods of intensive care from the standpoint of evidence-based medicine are widely used for their treatment. Along with intensive care, the comprehensive cytoprotective program using Neurocitin®, which contains citicoline and electrolytes, is of great importance. Neurocitin® has a combined effect aimed at correcting metabolic and volemic disorders, namely, maintaining adequate cerebral perfusion, timely elimination of water-electrolyte disorders, energy supply of brain tissues and protection of the neurovascular unit from damage. Lactate in the composition of Neurocitin® provides a detoxification effect, preserves and increases the energy supply of neurons, improves metabolism, cerebral blood flow and neuronal activity. For the treatment of TBI, the neurometabolic drug of ethylmethylhydroxypyridine succinate (Lodixem®) is also used. Lodixem® normalizes cerebral blood flow, provides an earlier resolution of post-traumatic encephalopathy and restoration of consciousness, leads to a decrease in the severity of endogenous intoxication syndrome, the elimination of pathological vicious circles that arise against the background of hypoxia, ischemia and energy deficiency in various organs and tissues.

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Cisternostomy is not beneficial to reduce the occurrence of post-traumatic hydrocephalus in Traumatic Brain Injury

Liu,

Zhang,

Chen

et al. 2024

Acta Neurochir

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Cisternostomy for traumatic brain injury—rigorous evaluation is necessary

Abstract: Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 7 publications

References 19 publications

The Role of Cisternostomy in the Management of Severe Traumatic Brain Injury: A Triple-Center Study

The Role of Cisternostomy in the Management of Severe Traumatic Brain Injury: A Triple-Center Study

Modern principles of diagnosis and treatment of severe traumatic brain injury

Cisternostomy is not beneficial to reduce the occurrence of post-traumatic hydrocephalus in Traumatic Brain Injury

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