Addition of Cisternostomy to Decompressive Hemi-craniectomy; Does It Lead to Better Functional Outcomes in Patients with Traumatic Brain Injury?

Introduction: Traumatic brain injury is a major health concern, globally. Surgical management is centered on decompression, with decompressive craniectomy forming the mainstay, however, while the procedure is associated with a mortality benefit, functional outcomes in terms of the 5-category Glasgow Outcome Scale remains poor. Adjuvant cisternostomy has been postulated to be of benefit in this regard.

Methods: We conducted a cross-sectional analytical study in Neurosurgery department, Shifa International Hospital, Islamabad from 20th April, 2020 to 20th October, 2020. A total of 74 patients with traumatic brain injury were enrolled. Patients were divided into two groups by lottery method, after informed consent. Group A was managed with decompressive craniectomy plus cisternostomy, while Group B received decompressive craniectomy alone. Glasgow coma scale was noted pre-operatively, and Glasgow outcome scale was calculated at 6th week, which was used to classify patients into favourable and unfavourable outcomes. Data was analyzed using SPSS 26.0.

Results: The mean age of our sample was 37.39 ± 12.03 years, majority of these patients were male i.e., 58 (78.4%). A total of 59 (78.3%) suffered injury secondary to road traffic accidents, and most developed sub-dural haematomas followed closely by intracerebral haemorrhage, 38 (51.4%) and 31 (41.9%), respectively. Post-surgery, patients who underwent decompressive craniectomy with cisternostomy had a better overall mean Glasgow Outcome Scale score i.e., 3.95 ± 0.78 versus 3.14 ± 1.44 in those who underwent decompressive craniectomy alone, (p=0.004), this is translated into more favourable outcomes in the former group: 29 (39.2%) versus 14 (18.9%) in the latter, (p < 0.001). A majority 78.4% of patients who underwent decompression craniectomy with cisternostomy had a favourable outcome versus 37.8% in in decompressive craniectomy alone group.

Conclusion : Decompressive craniectomy with cisternostomy is superior to decompressive craniectomy alone in terms of Glasgow outcome scale at six weeks post-surgery. However, further research is still required.