Recent advance in cisternostomy in treatment of severe traumatic brain injury / 中华神经医学杂志

At present, the most commonly used surgical measures for treatment of severe traumatic brain injury (sTBI) mainly include external ventricular puncture and drainage (EVD), decompressive craniectomy (DC), intracranial hematoma clearance and intracerebral decompression of contusion and laceration. All of these procedures can reduce intracranial pressure (ICP) and mortality, but they have the disadvantage of high postoperative adverse functional outcomes. With further study of glyymphatic system and intracranial microsurgery, some scholars have proposed a new neurosurgical technique: cisternostomy, which could achieve good results in the treatment of some refractory intracranial hypertension patients with sTBI. In this paper, we will summarize the recent advance in cisternostomy in the treatment of sTBI by reviewing the relevant literature at domestic and abroad in recent years, including the systematic evaluation of its pathophysiological basis, surgical techniques, surgical indications and contraindications, and surgical efficacy.

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

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 hugemidline 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.

Surgical Outcome of Endoscopic Cysto-Cisternostomy for Arachnoid Cyst

Arachnoid cysts are present in 1% of the populace and generally found in the temporal, frontal, pineal and posterior fossa, frontotemporal fossa. Clinical and radiologic introductions can vary incredibly. In spite of serious research, it is as yet easily proven wrong which patients will profit by medical procedure. Objective: This study intends to research the pre-treatment parameters impacting the result after neuro-endoscopic treatment of arachnoid cysts. Methods: A review investigation of 14 patients who experienced an endoscopic fenestration of arachnoid cysts between 2012 to 2017. Results: In symptomatic patients, 85.71 percent of cases have improved clinically. The best results in treating symptoms related to intracranial hypertension, acute neurological defects and macrocrania and seizure were found. Conclusion: The clinical outcome and complication rate vary by technique and symptomatology, although the outcome after the endoscopic cysto cysternostomy is satisfactory.

Effect of cisternostomy on prognosis of patients with traumatic brain injury / 中华创伤杂志

Objective To investigate the effect of cisternostomy on the prognosis of patients with traumatic brain injury (TBI).Methods A retrospective case control study was conducted to analyze the clinical data of 46 patients with TBI admitted to Shanxi Dayi Hospital from May 2017 to September 2018.There were 37 males and nine females,aged 24-80 years [(49.8 ± 15.7)years].The injury severity score (ISS) was 6-42 points [(25.0 ± 8.2)points],and the Glasgow Coma score (GCS) was 3-14 points [(3.4 ± 1.7) points].Twenty-three patients underwent routine surgery only (control group),and 23 patients underwent cisternostomy (cisternostomy group) on the basis of routine surgery.Intracranial pressure monitoring was performed in both groups before surgery.The postoperative intracranial pressure,intracranial pressure 1 week after operation,postoperative mechanical ventilation time,neurosurgical ICU (NICU) time,postoperative dehydration dose,decompressive craniectomy rate,postoperative infection rate,mortality rate,length of hospital stay,GCS at discharge,and Glasgow outcome score (GOS) of 3 months of follow-up were compared between the two groups.Results Compared with the control group,the cistemostomy group had lower postoperative intracranial pressure [(7.1 ± 5.7) mmHg vs.(14.2 ± 12.0) mmHg)],intracranial pressure 1 week after operation [(11.8 ± 0.5) mmHg vs.(14.0 ± 0.7) mmHg],postoperative dosage of dehydrating agent [0 (0-500.0) ml vs.1 275 (787.5-3 812.5) ml] and decompression rate (57％ ∶ 91％) (P ＜ 0.05).There were no significant differences between the cistemostomy group and control group in postoperative mechanical ventilation time [120 (42.0-225.0)hours vs.89(65.5-203.5)hours],NICU time [236(182.0-340.5)hoursvs.281 (114-400)hours],postoperative infection rate (4％ vs.0),mortality rate (13％ vs.39％) and hospital stay [32 (20.0-44.5) hours vs.25 (12.0-30.5)hours] (P ＞ 0.05).The cisternostomy group had higher GCS score at discharge than the control group [(10.7 ± 4.2) points vs.(7.9 ± 4.2) points] (P ＜ 0.05).After 3 months of follow-up,18 patients in the cisternostomy group showed good prognosis,better than that in the control group (11 patients) (P ＜ 0.05).Conclusion For TBI patients,cisternostomy can clear the blood cerebrospinal fluid,reduce harmful metabolic products in the brain,reduce intracranial pressure and hence improve the prognosis of patients.