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
