Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2022; 19(01): 034-039
DOI: 10.1055/s-0041-1726224
Systematic Review

Cisternostomy in Traumatic Brain Injury for a Novel Approach to Treatment: Review of Current Status

Manish Agrawal
1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
,
Keshav Mishra 
1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
,
Rohit Babal
1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
,
Devendra Purohit
1   Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Cisternostomy (CS) is a recently introduced procedure to mitigate the cerebrospinal fluid shift edema and secondary injury in traumatic brain injury patients. There have been numerous reports describing its efficacy in various cohorts of traumatic brain injury (TBI) patients; therefore, we review the current evidences examining its utility for the same. The systematic review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline including all human studies published in English language indexed with MEDLINE and Google Scholar since 2013 evaluating CS as a standalone or as an adjuvant procedure. The studies were graded according to the Oxford center for evidence-based medicine levels of evidence. Case reports were excluded from the analysis. A total of 107 articles were found by using the given search criteria. Finally, three oxford level 3 study and one level 4 study were included in the analysis. CS in combination with decompressive craniectomy was seen to confer mortality benefit and better outcome at discharge. It led to statistically significant improvement in clinical outcome at 6 months in the patients for whom it was performed as a primary procedure. CS is a promising procedure in TBI leading to survival benefit as well as better clinical outcome. But the level of evidence supporting its effectiveness is still weak owing to the methodological limitations and small sample size. A well-designed multicentric randomized controlled trial is needed to critically examine its role in TBI patients.

Keywords

cisternostomy - traumatic brain injury - CSF shift edema - Virchow-Robin spaces


Publication History

Article published online:
08 April 2021

© 2021. Neurotrauma Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3 (11) e442
    CrossrefPubMedGoogle Scholar
  • 2 Rossini Z, Nicolosi F, Kolias AG, Hutchinson PJ, De Sanctis P, Servadei F. The history of decompressive craniectomy in traumatic brain injury. Front Neurol 2019; 10: 458
    CrossrefPubMedGoogle Scholar
  • 3 Hutchinson PJ, Kolias AG, Timofeev IS. et al RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 2016; 375 (12) 1119-1130
    CrossrefPubMedGoogle Scholar
  • 4 Cherian I, Yi G, Munakomi S. Cisternostomy: replacing the age old decompressive hemicraniectomy?. Asian J Neurosurg 2013; 8 (03) 132-138
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Cherian I, Beltran M, Landi A, Alafaci C, Torregrossa F, Grasso G. Introducing the concept of “CSF-shift edema” in traumatic brain injury. J Neurosci Res 2018; 96 (04) 744-752
    CrossrefPubMedGoogle Scholar
  • 6 Group OLoEW. The Oxford levels of evidence 2. 2011. Available at: www.cebm.net/index.aspx?o=5653. Accessed June 20, 2020
    PubMed
  • 7 Simard JM, Kent TA, Chen M, Tarasov KV, Gerzanich V. Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol 2007; 6 (03) 258-268
    CrossrefPubMedGoogle Scholar
  • 8 Iliff JJ, Wang M, Liao Y. et al A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloidβ. Sci Transl Med 2012; 4 (147) 147ra111-147ra11
    CrossrefPubMedGoogle Scholar
  • 9 Iliff JJ, Chen MJ, Plog BA. et al Impairment of glymphatic pathway function promotes tau pathology after traumatic brain injury. J Neurosci 2014; 34 (49) 16180-16193
    CrossrefPubMedGoogle Scholar
  • 10 Yang L, Kress BT, Weber HJ. et al Evaluating glymphatic pathway function utilizing clinically relevant intrathecal infusion of CSF tracer. J Transl Med 2013; 11 (01) 107
    CrossrefPubMedGoogle Scholar
  • 11 Bothwell SW, Janigro D, Patabendige A. Cerebrospinal fluid dynamics and intracranial pressure elevation in neurological diseases. Fluids Barriers CNS 2019; 16 (01) 9
    CrossrefPubMedGoogle Scholar
  • 12 Goyal N, Kumar P. Putting ‘CSF-shift’ edema hypothesis to test: Comparing cisternal and parenchymal pressures after basal cisternostomy for head injury. World Neurosurg 2021; S1878–8750 (20) 32700-32705
    PubMedGoogle Scholar
  • 13 Goyal N, Kumar P, Chaturvedi J, Siddiqui SA, Agrawal D. Basal cisternostomy in traumatic brain injury: an idea whose time has come?. Indian Journal of Neurotrauma 2020; 17 (01) 03-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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 (03) 14-20
    CrossrefPubMedGoogle Scholar
  • 15 Giammattei L, Starnoni D, Maduri R. et al Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma. Acta Neurochir (Wien) 2020; 162 (03) 469-479
    CrossrefPubMedGoogle Scholar
  • 16 Cherian I, Burhan H. Outcomes of severe head injury patients undergoing Cisternostomy from a tertiary care hospital in Nepal. Indonesian Journal of Neurosurgery 2019;2(3)
    PubMed