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Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma
OBJECTIVE: To evaluate the value of an adjuvant cisternostomy (AC) to decompressive craniectomy (DC) for the management of patients with severe traumatic brain injury (sTBI). METHODS: A single-center retrospective quality control analysis of a consecutive series of sTBI patients surgically treated w...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Vienna
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046565/ https://www.ncbi.nlm.nih.gov/pubmed/32016585 http://dx.doi.org/10.1007/s00701-020-04222-y |
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author | Giammattei, Lorenzo Starnoni, Daniele Maduri, Rodolfo Bernini, Adriano Abed-Maillard, Samia Rocca, Alda Cossu, Giulia Simonin, Alexandre Eckert, Philippe Bloch, Jocelyne Levivier, Marc Oddo, Mauro Messerer, Mahmoud Daniel, Roy Thomas |
author_facet | Giammattei, Lorenzo Starnoni, Daniele Maduri, Rodolfo Bernini, Adriano Abed-Maillard, Samia Rocca, Alda Cossu, Giulia Simonin, Alexandre Eckert, Philippe Bloch, Jocelyne Levivier, Marc Oddo, Mauro Messerer, Mahmoud Daniel, Roy Thomas |
author_sort | Giammattei, Lorenzo |
collection | PubMed |
description | OBJECTIVE: To evaluate the value of an adjuvant cisternostomy (AC) to decompressive craniectomy (DC) for the management of patients with severe traumatic brain injury (sTBI). METHODS: 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(2)) values as well as the need for additional osmotherapy and CSF drainage. RESULTS: 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(2) values and required less osmotic treatments as compared with those treated with DC alone. CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-7046565 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Vienna |
record_format | MEDLINE/PubMed |
spelling | pubmed-70465652020-03-13 Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma Giammattei, Lorenzo Starnoni, Daniele Maduri, Rodolfo Bernini, Adriano Abed-Maillard, Samia Rocca, Alda Cossu, Giulia Simonin, Alexandre Eckert, Philippe Bloch, Jocelyne Levivier, Marc Oddo, Mauro Messerer, Mahmoud Daniel, Roy Thomas Acta Neurochir (Wien) Original Article - Brain trauma OBJECTIVE: To evaluate the value of an adjuvant cisternostomy (AC) to decompressive craniectomy (DC) for the management of patients with severe traumatic brain injury (sTBI). METHODS: 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(2)) values as well as the need for additional osmotherapy and CSF drainage. RESULTS: 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(2) values and required less osmotic treatments as compared with those treated with DC alone. CONCLUSION: 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. Springer Vienna 2020-02-03 2020 /pmc/articles/PMC7046565/ /pubmed/32016585 http://dx.doi.org/10.1007/s00701-020-04222-y Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article - Brain trauma Giammattei, Lorenzo Starnoni, Daniele Maduri, Rodolfo Bernini, Adriano Abed-Maillard, Samia Rocca, Alda Cossu, Giulia Simonin, Alexandre Eckert, Philippe Bloch, Jocelyne Levivier, Marc Oddo, Mauro Messerer, Mahmoud Daniel, Roy Thomas Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
title | Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
title_full | Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
title_fullStr | Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
title_full_unstemmed | Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
title_short | Implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
title_sort | implementation of cisternostomy as adjuvant to decompressive craniectomy for the management of severe brain trauma |
topic | Original Article - Brain trauma |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046565/ https://www.ncbi.nlm.nih.gov/pubmed/32016585 http://dx.doi.org/10.1007/s00701-020-04222-y |
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