Outcomes of severe head injury patients undergoing Cisternostomy from a tertiary care hospital in Nepal

Background: Cisternostomy incorporates micro-neurosurgery to unfold the brain, allowing wider access to optico-carotid window. The Cisterns are drained after opening the membrane of Lillequest, significantly reducing the intra-parenchymal pressures due to CSF-Shift edema occurring in the setting of moderate to severe traumatic brain injury. It is important to consider the time of intervention following brain trauma, which determine the surgical procedure undertaken for best outcomes.

Methodology: A retrospective study was conducted to obtain data for 50 patients undergoing Cisternostomy between January to September 2018, with a presenting GCS of less than 8, as the primary surgical management for decreasing intra-parenchymal pressures secondary to severe traumatic brain injury. Outcomes were assessed at a 2 months follow-up using Glasgow Outcome Scale. All data was entered and analyzed using SPSS Software.

Results: Out of 50 patients, 70% were males and 30% females.  38% patients belonged to ages between 21 to 40 years. Out of 50 patients with GCS less than 8, 4 patients had bilaterally non-reactive pupils. In almost all patients (n=48), bone flap was replaced after complete brain relaxation was achieved. Post-operative CT scans showed opening of suprasellar cisterns (n=45).  The average ICU days and ventilator days were approximately 3 and 2, respectively. Follow-up on 2 months using GOS showed a good recovery (n= 38), moderate disability (n= 4), severe disability (n=3) and dead (n=5)

Conclusion: Cisternostomy provides promising outcomes in severe brain injuries by effectively decreasing intraparenchymal pressures and preventing axonal injury which manifest as a later sequel in brain trauma.