Basal Cisternostomy for Severe TBI: Surgical Technique and Cadaveric Dissection

Giammattei, Lorenzo; Starnoni, Daniele; Messerer, Mahmoud; Daniel, Roy Thomas

doi:10.3389/fsurg.2022.915818

Cited by 8 publications

(10 citation statements)

References 19 publications

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“…In another retrospective study, Giammattei et al found that patients treated with DC and cisternostomy had better clinical outcomes [ 6 ]. The same group described cisternostomy’s cadaveric dissection and surgical technique in a separate paper [ 5 ]. A previous case report by our group demonstrated the effect of cisternostomy in decreasing ICP and its potential role as a surgical treatment for pseudotumor cerebri [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent advances indicate that ventricular CSF does not communicate with parenchymal IF [ 5 , 6 , 8 ]. As a result, CSF diversion from the ventricular system does not have a strong effect in increasing IF drainage and subsequently decreasing edema and ICP.…”

Section: Discussionmentioning

confidence: 99%

“…A recent potential management for patients with TBI is cisternostomy with DC. Cisternostomy with DC has been shown to have better outcomes than DC alone in patients with TBI [5][6][7]. Recent advances indicate that cisternal CSF communicates with cerebral interstitial fluid (IF) through Virchow-Robin spaces.…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances indicate that cisternal CSF communicates with cerebral interstitial fluid (IF) through Virchow-Robin spaces. Theoretically, opening cisterns to atmospheric pressure may induce IF drainage and subsequently decrease ICP [ 5 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Cisternostomy as a Surgical Treatment for Traumatic Brain Injury-Related Prolonged and Delayed Intracranial Pressure Elevation: A Case Report

Eraky¹,

Treffy²,

Hedayat³

2023

Cureus

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Traumatic brain injury (TBI) can be classified into primary, due to the effect of the initial trauma, or secondary, due to increased intracranial pressure (ICP). Increased ICP may cause brain herniation and also decreases cerebral blood perfusion leading to ischemia. Recently, a few studies showed that cisternostomy with decompressive craniectomy (DC) has better outcomes than DC alone in patients with TBI. This can be explained by the recent advances indicating that cisternal cerebrospinal fluid (CSF) communicates with cerebral interstitial fluid (IF) through Virchow-Robin spaces. Theoretically, opening cisterns to atmospheric pressure may induce IF drainage and subsequently decrease ICP. A 55-year-old man presented to the emergency department with subdural hematomas, hemorrhagic contusions, and subarachnoid hemorrhage after falling off a moving truck. ICP elevation was refractory despite increased sedation, initiation of paralysis with Cisatracurium, esophageal cooling, multiple doses of 23.4 % saline and mannitol, and DC. Lumbar drain (LD) placement was performed with beneficial results. Unfortunately, the LD stopped functioning multiple times and each time this occurred, he developed increased ventricular size with elevated ICP. The patient underwent cisternostomy and lamina terminalis fenestration. No further increased ICPs were observed after cisternostomy at a one-month follow-up. Cisternostomy is a potential surgical treatment for patients with TBI-related prolonged ICP elevation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cisternostomy as a Surgical Treatment for Traumatic Brain Injury-Related Prolonged and Delayed Intracranial Pressure Elevation: A Case Report

Eraky¹,

Treffy²,

Hedayat³

2023

Cureus

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“…Allowing CSF drainage through the cisterns by surgically opening them to atmospheric pressure may stimulate CSF and interstitial fluid drainage through the Virchow-Robin spaces, subsequently decreasing ICP [ 10 ]. Many previous clinical studies have shown that cisternotomy with decompressive craniotomy (DC) is associated with better outcomes when compared to DC alone in patients with traumatic brain injury [ 10 , 11 ]. Theoretically, other causes of increased ICP, such as IIH, can benefit from cisternotomy.…”

Section: Discussionmentioning

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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The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies

Hossain,

Rostami,

Marklund

2023

Current Opinion in Critical Care

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Purpose of review To provide an overview of recent studies discussing novel strategies, controversies, and challenges in the management of severe traumatic brain injury (sTBI) in the initial postinjury hours. Recent findings Prehospital management of sTBI should adhere to Advanced Trauma Life Support (ATLS) principles. Maintaining oxygen saturation and blood pressure within target ranges on-scene by anesthetist, emergency physician or trained paramedics has resulted in improved outcomes. Emergency department (ED) management prioritizes airway control, stable blood pressure, spinal immobilization, and correction of impaired coagulation. Noninvasive techniques such as optic nerve sheath diameter measurement, pupillometry, and transcranial Doppler may aid in detecting intracranial hypertension. Osmotherapy and hyperventilation are effective as temporary measures to reduce intracranial pressure (ICP). Emergent computed tomography (CT) findings guide surgical interventions such as decompressive craniectomy, or evacuation of mass lesions. There are no neuroprotective drugs with proven clinical benefit, and steroids and hypothermia cannot be recommended due to adverse effects in randomized controlled trials. Summary Advancement of the prehospital and ED care that include stabilization of physiological parameters, rapid correction of impaired coagulation, noninvasive techniques to identify raised ICP, emergent surgical evacuation of mass lesions and/or decompressive craniectomy, and temporary measures to counteract increased ICP play pivotal roles in the initial management of sTBI. Individualized approaches considering the underlying pathology are crucial for accurate outcome prediction.

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Basal Cisternostomy for Severe TBI: Surgical Technique and Cadaveric Dissection

Cited by 8 publications

References 19 publications

Cisternostomy as a Surgical Treatment for Traumatic Brain Injury-Related Prolonged and Delayed Intracranial Pressure Elevation: A Case Report

Cisternostomy as a Surgical Treatment for Traumatic Brain Injury-Related Prolonged and Delayed Intracranial Pressure Elevation: A Case Report

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

The management of severe traumatic brain injury in the initial postinjury hours – current evidence and controversies

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