Microsurgical cisternostomy as an alternative for decompressive craniectomy in patients victims of diffuse traumatic brain injury

Introduction: Traumatic brain injury (TBI) is a major cause of mortality around the world especially in developing countries. Few advances regarding surgical approaches have been made in the past few years for improve its outcomes. Microsurgical cisternostomy is a well stablished technique used in vascular and skull base surgery and recently emerges as a suitable procedure with lesser costs and morbidity when compared to decompressive craniectomy (DC) in patients with diffuse TBI. Brazilian study has shown that the mean direct cost of DC was R$ 66,155.00.

Objective: Describe cisternostomy technique and compare their results with DC.

Methods: Ethics Committee approval was obtained for a prospective study considering all patients victims of diffuse TBI between 18–70 years and without multisystemic lesions. Microsurgical cisternostomy is made through basal cistern and lamina terminalis opening. Pre and post-operative CT and neurological examination was evaluated.

Results: Until now, two patients were submitted to cisternostomy. Both presented with severe TBI with acute subdural hematoma and huge midline shift at admission CT. The surgery was authorized by family (Consent Form was assigned) and was performed before 12 hours after the trauma. Both patients evolved with a good neurological recovery after the procedure (GOS of 4 and 5), and a satisfactory control brain CT with no midline shift and no edema. No further surgeries were required after the initial cisternostomy. Decompressive craniectomy and further cranioplasty were not required after the cistern opening.

Conclusions: Cisternostomy is an adequate technique for treatment of selected patient’s victims of diffuse TBI and a proper alternative for decompressive craniectomy with lesser morbidity once a single neurosurgical procedure is performed.