Skip to main content Skip to main navigation menu Skip to site footer

The effectivity and safety of cisternostomy and decompressive craniectomy as management of brain trauma: a systematic review and meta-analysis



Abstract

Introduction: Traumatic brain injury (TBI) is the disease that causes the most common disability globally. The cisternostomy as adjuvant management of TBI lacks documentation. We aim to prove the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury.

Methods: The search for published scientific articles using the Preferred Reporting, Items for Systematic Reviews, and Meta-Analysis (PRISMA) method. The search was conducted using the PubMed, Cochrane library, and Medline databases published in English for the last ten years until June 2022, evaluating the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury. The Oxford Center for Evidence-based medicine assessed the evidence levels of each study. Data analysis with RevMan version 5.3.

Results: Four studies were included in this meta-analysis, two RCTs, and two observational studies. We find a total of 1000 patients with; 596 cisternostomies and 404 decompressive craniectomies. These primary points show that mean GOS at six weeks is 0.93 (I2:52%; 95%CI: 0.70 to 1.17; p<0,01), decrease in intracranial pressure post-operation is -3.20 mmHg (I2:97%; 95%CI: -3.84 to -2.56; p<0,01), duration of ICU stay is -2.37 days (I2:37%; 95%CI: -4.54 to -0.21; p<0,03), and mortality is 0.51 (I2:21%; 95%CI: 0.42 to 0.63; p<0,01).

Conclusion: Cisternostomy is a beneficial procedure in TBI, leading to survival benefits and better clinical outcomes. Hopefully, more studies will examine its role in TBI patients critically in the future.

Keywords: Cisternostomy Decompressive Craniectomy Management Outcome Traumatic brain injury
Section

References

  1. Ng SY, Lee AY. Traumatic brain injuries: pathophysiology and potential therapeutic targets. Frontiers in cellular neuroscience. 2019;13:528. doi: 10.3389/fncel.2019.00528
  2. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. Journal of neurosurgery. 2018;130(4):1080-97. doi: 10.3171/2017.10.JNS 17352
  3. Maas AI, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology. 2017;16(12):987-1048. doi: 10.1016/S1474- 4422(17)30371-X
  4. Rahmanian A, Haghnegahdar A, Ghaffarpasand F. Effects of intracranial pressure monitoring on outcome of patients with severe traumatic brain injury; results of a historical cohort study. Bull Emerg Trauma. 2014;2:151-155
  5. Giammattei L, Starnoni D, Maduri R, Bernini A, Abed-Maillard S, Rocca A, Cossu G, Simonin A, Eckert P, Bloch J, Levivier M. Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma. Acta neurochirurgica. 2020;162:469-79.https://doi.org/10.1007/s00701-020-04222-y
  6. Cherian I, Yi G, Munakomi S. Cisternostomy: Replacing the age old decompressive hemicraniectomy?. Asian Journal of Neurosurgery. 2013;8(03):132-8. https://doi.org/10.4103/1793-5482.121684
  7. Chandra VR, Prasad BC, Banavath HN, Reddy KC. Cisternostomy versus decompressive craniectomy for the management of traumatic brain injury: a randomized controlled trial. World Neurosurgery. 2022;162:e58-64. https://doi.org/10.1016/j.wneu.2022.02.067
  8. Iliff JJ, Chen MJ, Plog BA, Zeppenfeld DM, Soltero M, Yang L, et al. Impairment of glymphatic pathway function promotes tau pa- thology after traumatic brain injury. J Neurosci. 2014;34:16180-16193
  9. Cherian I, Burhan H. Outcomes of severe head injury patients undergoing cisternostomy at tertiary care hospital in Nepal. IJN. 2019;2:55-59
  10. Giammattei L, Messerer M, Cherian I, Starnoni D, Maduri R, Kasper EM, et al. Implementation of cisternostomy as Adjuvant to decompressive craniectomy for the management of severe brain trauma. Acta Neurochirurgica. 2020;(2020)162:469–479 https://doi.org/10.1007/s00701-020-04222-y
  11. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6-15. https://doi.org/ 10.1227/NEU.0000000000001432
  12. Vella MA, Crandall ML, Patel MB. Acute management of traumatic brain injury. Surgical Clinics. 2017;97(5):1015-30. http://dx.doi.org/10.1016/j.suc.2017.06.00.
  13. Cherian I, Burhan H, Dashevskiy G, Motta SJ, Parthiban J, Wang Y, et al. Cisternostomy: a timely intervention in moderate to severe traumatic brain injuries: rationale, indications, and prospects. World Neurosurg. 2019; 131:385-390.
  14. Thapa A, Adhikari RB, Bidur KC, Shakya B. Role of cisternal drainage in patients with traumatic brain injury undergoing decompressive craniectomy. Nepal Journal of Neuroscience. 2018;15(3):14-20.
  15. Parthiban JK, Sundaramahalingam S, Rao JB, Nannaware VP, Rathwa VN, Nasre VY, et al. Basal cisternostomy—a microsurgical cerebrospinal fluid let out procedure and treatment option in the management of traumatic brain injury. Analysis of 40 consecutive head injury patients operated with and without bone flap replacement following cisternostomy in a tertiary care centre in India. Neurol India. 2021;69:328-333.
  16. Goyal N, Kumar P. Putting ‘CSF-shift edema’ hy- pothesis to test: comparing cisternal and parenchymal pressures after basal cisternostomy for head injury. World Neurosurg. 2021;148:e252-e263.
  17. Peeters W, van den Brande R, Polinder S, et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir. 2015;157:1683-1696.
  18. Rodríguez-Triviño CY, Torres Castro I, Dueñas Z. Hypochloremia in Patients with Severe Traumatic Brain Injury: A Possible Risk Factor for Increased Mortality. World Neurosurg. 2019;124: e783-e788. [PubMed]
  19. Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhao LR. Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors. Cell Transplant. 2017;26(7):1118-1130. [PMC free article]
  20. Ginsburg J, Huff JS. Closed Head Trauma. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL):2022. [PubMed]
  21. Cherian I, Burhan H, Dashevskiy G, et al. Cis- ternostomy: a timely intervention in moderate to severe traumatic brain injuries: rationale, in- dications, and prospects. World Neurosurg. 2019; 131:385-390.
  22. Giammattei L, Messerer M, Cherian I, et al. Cur- rent perspectives in the surgical treatment of severe traumatic brain injury. World Neurosurg. 2018; 116:322-328.
  23. Heuts SG, Bruce SS, Zacharia BE, Hickman ZL, Kellner CP, Sussman ES, et al. Decompressive hemicraniectomy without clot evacuation in dominant‐sided intracerebral hemorrhage with ICP crisis. Neurosurg Focus. 2013;34:E4.
  24. Wettervik TS, Lenell S, Nyholm L, Howells T, Lewén A, Enblad P, et al. Decompressive craniectomy in traumatic brain injury: Usage and clinical outcome in a single centre. Acta Neurochir (Wien). 2018;160:229‐37.
  25. Honeybul S, Ho KM, Lind CR, Gillett GR. Validation of the CRASH model in the prediction of 18‐month mortality and unfavorable outcome in severe traumatic brain injury requiring decompressive craniectomy. J Neurosurg. 2014;120:1131‐7.

How to Cite

Satyarsa, A. B. S., Wardhana, D. P. W. ., Brahmantya, I. B. Y. ., Rosyid, R. M. ., & Maliawan, S. . (2023). The effectivity and safety of cisternostomy and decompressive craniectomy as management of brain trauma: a systematic review and meta-analysis. Indonesia Journal of Biomedical Science, 17(1), 38–46. https://doi.org/10.15562/ijbs.v17i1.448
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
302

Total
246

Share

Search Panel

Agung Bagus Sista Satyarsa
Google Scholar
Pubmed
IJBS Journal

Dewa Putu Wisnu Wardhana
Google Scholar
Pubmed
IJBS Journal

Ida Bagus Yorky Brahmantya
Google Scholar
Pubmed
IJBS Journal

Rohadi Muhammad Rosyid
Google Scholar
Pubmed
IJBS Journal

Sri Maliawan
Google Scholar
Pubmed
IJBS Journal