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Microsurgical Cisternostomy for Treating Critical Patients with Traumatic Brain Injury - An alternative Therapeutic Approach
Campos Paiva, Aline Lariessy; Vitorino Araujo, João Luiz; Lovato, Renan Maximilian; Esteves Veiga, José Carlos.
  • Campos Paiva, Aline Lariessy; Department of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). São Paulo. BR
  • Vitorino Araujo, João Luiz; Department of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). São Paulo. BR
  • Lovato, Renan Maximilian; Department of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). São Paulo. BR
  • Esteves Veiga, José Carlos; Department of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). São Paulo. BR
Arq. bras. neurocir ; 39(3): 155-160, 15/09/2020.
Article in English | LILACS | ID: biblio-1362402
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 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.
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Full text: Available Index: LILACS (Americas) Main subject: Decompressive Craniectomy / Brain Injuries, Traumatic / Microsurgery Type of study: Practice guideline / Observational study Limits: Aged / Female / Humans / Male Language: English Journal: Arq. bras. neurocir Journal subject: Cirurgia / Neurosurgery Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Department of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP)/BR

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Full text: Available Index: LILACS (Americas) Main subject: Decompressive Craniectomy / Brain Injuries, Traumatic / Microsurgery Type of study: Practice guideline / Observational study Limits: Aged / Female / Humans / Male Language: English Journal: Arq. bras. neurocir Journal subject: Cirurgia / Neurosurgery Year: 2020 Type: Article Affiliation country: Brazil Institution/Affiliation country: Department of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP)/BR