Cisternostomy versus Decompressive Craniectomy for the Management of Traumatic Brain Injury: A Randomized Controlled Trial

Chandra, Varun; mowliswara, Prasad Bodapati Chandra; Banavath, Hanuma Naik; Kalakoti, Chandra Sekhar Reddy

doi:10.1016/j.wneu.2022.02.067

Cited by 27 publications

(42 citation statements)

References 15 publications

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“…A proper basal craniotomy and a rapid extradural sphenoidal drilling till the superior orbital fissure can be rapidly accomplished with an acceptable extra-time of approximately 15-20 min when compared to a standard trauma flap. This slight increase in terms of amount of time has been found also by Chandra et al (5). It is to be specified that this increased time includes the extradural sphenoidal drilling and the intradural phase of cisternal opening and positioning of the cisternal drain.…”

Section: Discussionsupporting

confidence: 70%

“…A previous clinical study of our group (4) has showed that adjuvant cisternostomy is associated with an improved outcome (both at early and long term), improved brain oxygenation, better control of ICP and shorter ICU stay when compared to standard decompressive craniectomy (DC). A recent randomized trial by Chandra et al (5) has also confirmed the benefit of cisternostomy in terms of outcome and ICP control when compared to standard DC. However, discordances exist between the different authors concerning the surgical technique (6).…”

Section: Introductionmentioning

confidence: 85%

“…Cisternostomy represents a novel surgical strategy to treat severe TBI. There are now several publications that show encouraging results for cisternostomy over traditional methods of treatment for sTBI (4,5,7). Different surgical techniques have been described in the literature some including an extradural anterior clinoidectomy (and posterior clinoidectomy in some cases) (8) and other less aggressive ones (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…There are now several publications that show encouraging results for cisternostomy over traditional methods of treatment for sTBI (4,5,7). Different surgical techniques have been described in the literature some including an extradural anterior clinoidectomy (and posterior clinoidectomy in some cases) (8) and other less aggressive ones (4,5). However, there has an undue emphasis given to the complexity of the surgical approach which has generated resistance to this technique within the neurosurgical community, that is essentially undeserved (9).…”

Section: Discussionmentioning

confidence: 99%

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Basal Cisternostomy for Severe TBI: Surgical Technique and Cadaveric Dissection

et al. 2022

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IntroductionCisternostomy is emerging as a novel surgical technique in the setting of severe brain trauma. Different surgical techniques have been proposed with a variable degree of epidural bone work. We present here the surgical technique as it is currently performed in our Institution.MethodsAnatomical dissection of one adult cadaveric head, injected and non-formalin fixed was perfomed. A large right fronto-temporo-parietal craniotomy was accomplished. Extradural sphenoidal drilling till opening of the superior orbital fissure was performed. The microsurgical anatomy of basal cisternostomy was then explored.ResultsA step by step description of the surgical technique, enriched with cadaveric and intraoperative images, was made.ConclusionBasal cisternostomy is a promising surgical technique that does not necessarily include complex surgical maneuvers. Trained neurosurgeon can safely implement it in their clinical practice.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Basal Cisternostomy for Severe TBI: Surgical Technique and Cadaveric Dissection

et al. 2022

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“…Theoretically, another potential treatment of IIH is subarachnoid basal cistern opening (cisternotomy). Cisternotomy is used during many microsurgical operations to relax the brain by removing or diverting CSF [ 7 ]. Recent developments indicate that CSF from the ventricles does not communicate with the parenchyma but rather CSF from the cisterns communicates with the parenchyma through the Virchow-Robin spaces via the glymphatic system [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cisternotomy and Liliequist’s Membrane Fenestration as a Surgical Treatment for Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): A Case Report

Eraky¹,

Treffy²,

Hedayat³

2022

Cureus

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Subarachnoid basal cistern opening (cisternotomy) is used during many microsurgical operations to relax the brain by removing or diverting cerebrospinal fluid (CSF). Recently, cisternotomy has been used in patients with traumatic brain injury to improve outcomes due to its ability to decrease intracranial pressure (ICP) and brain edema by diverting CSF. Theoretically, another condition that can benefit from cisternotomy is idiopathic intracranial hypertension (IIH) as it presents with manifestations of increased ICP, such as headache, vomiting, and papilledema. Here, we discuss the case of a 39-year-old woman with IIH who presented with headache, nausea, and papilledema in the setting of maximally tolerated medical management after five months of shunt removal due to infection. The patient did not want to proceed with the replacement of her shunt and therefore underwent a right eyebrow craniotomy for cisternotomy, lamina terminals fenestration, and Liliequist's membrane opening. Postoperatively, her symptoms improved completely. She was off acetazolamide altogether at the three-month follow-up and no longer had pseudotumor cerebri headaches. This case report demonstrates the use of cisternotomy to relieve the manifestations of increased ICP and its potential as a surgical option for patients with IIH.

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