Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_D6A29795AEDD
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma.
Journal
Acta neurochirurgica
Author(s)
Giammattei L., Starnoni D. (co-first), Maduri R., Bernini A., Abed-Maillard S., Rocca A., Cossu G., Simonin A., Eckert P., Bloch J., Levivier M., Oddo M., Messerer M., Daniel R.T.
ISSN
0942-0940 (Electronic)
ISSN-L
0001-6268
Publication state
Published
Issued date
03/2020
Peer-reviewed
Oui
Volume
162
Number
3
Pages
469-479
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
To evaluate the value of an adjuvant cisternostomy (AC) to decompressive craniectomy (DC) for the management of patients with severe traumatic brain injury (sTBI).
A single-center retrospective quality control analysis of a consecutive series of sTBI patients surgically treated with AC or DC alone between 2013 and 2018. A subgroup analysis, "primary procedure" and "secondary procedure", was also performed. We examined the impact of AC vs. DC on clinical outcome, including long-term (6 months) extended Glasgow outcome scale (GOS-E), the duration of postoperative ventilation, and intensive care unit (ICU) stay, mortality, Glasgow coma scale at discharge, and time to cranioplasty. We also evaluated and analyzed the impact of AC vs. DC on post-procedural intracranial pressure (ICP) and brain tissue oxygen (PbO <sub>2</sub> ) values as well as the need for additional osmotherapy and CSF drainage.
Forty patients were examined, 22 patients in the DC group, and 18 in the AC group. Compared with DC alone, AC was associated with significant shorter duration of mechanical ventilation and ICU stay, as well as better Glasgow coma scale at discharge. Mortality rate was similar. At 6-month, the proportion of patients with favorable outcome (GOS-E ≥ 5) was higher in patients with AC vs. DC [10/18 patients (61%) vs. 7/20 (35%)]. The outcome difference was particularly relevant when AC was performed as primary procedure (61.5% vs. 18.2%; p = 0.04). Patients in the AC group also had significant lower average post-surgical ICP values, higher PbO <sub>2</sub> values and required less osmotic treatments as compared with those treated with DC alone.
Our preliminary single-center retrospective data indicate that AC may be beneficial for the management of severe TBI and is associated with better clinical outcome. These promising results need further confirmation by larger multicenter clinical studies. The potential benefits of cisternostomy should not encourage its universal implementation across trauma care centers by surgeons that do not have the expertise and instrumentation necessary for cisternal microsurgery. Training in skull base and vascular surgery techniques for trauma care surgeons would avoid the potential complications associated with this delicate procedure.
Keywords
Cisternostomy, Decompressive craniectomy, Intracranial hypertension, Traumatic brain injury
Pubmed
Web of science
Open Access
Yes
Create date
06/02/2020 18:20
Last modification date
04/08/2021 6:37
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