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 (PbO2) 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 PbO2 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.

中文翻译：

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实施水箱造口术作为减压颅骨切除术的辅助药物，以治疗严重的脑外伤。

目的评估辅助性颅脑吻合术（AC）对减压颅骨切除术（DC）在重度颅脑外伤（sTBI）患者治疗中的价值。方法对2013年至2018年间连续接受AC或DC手术治疗的连续sTBI患者系列进行单中心回顾性质量控制分析。还进行了亚组分析，即“主要手术”和“次要手术”。我们检查了AC与DC对临床结局的影响，包括长期（6个月）延长的格拉斯哥结局量表（GOS-E），术后通气时间，重症监护病房（ICU）停留时间，死亡率，格拉斯哥昏迷出院时结垢，并进行颅骨成形术。我们还评估并分析了AC与VS的影响。DC对术后颅内压（ICP）和脑组织氧（PbO2）值的影响，以及是否需要进行其他渗透疗法和CSF引流。结果共检查了40例患者，DC组22例，AC组18例。与单独使用DC相比，AC与机械通气时间和ICU停留时间显着缩短以及出院时格拉斯哥昏迷评分更好有关。死亡率相似。AC组与DC组在6个月时，具有良好结局（GOS-E≥5）的患者比例更高[10/18患者（61％）对7/20（35％）]。当进行AC作为主要手术时，结局差异尤为重要（61.5％对18.2％； p = 0.04）。AC组的患者术后平均ICP值也明显较低，与单独使用DC相比，PbO2值更高，所需的渗透处理更少。结论我们初步的单中心回顾性数据表明AC可能对重度TBI的治疗有益，并与更好的临床结果相关。这些有希望的结果需要更大的多中心临床研究进一步证实。胸水吻合术的潜在好处不应该鼓励没有手术技能的外科医生在水疗中心的创伤护理中心普遍实施。对颅骨外科医生进行颅底和血管外科手术技术的培训将避免与这种精密手术相关的潜在并发症。结论我们初步的单中心回顾性数据表明AC可能对重度TBI的治疗有益，并与更好的临床结果相关。这些有希望的结果需要更大的多中心临床研究进一步证实。胸水吻合术的潜在好处不应该鼓励没有手术技能的外科医生在水疗中心的创伤护理中心普遍实施。对颅骨外科医生进行颅底和血管外科手术技术的培训将避免与这种精密手术相关的潜在并发症。结论我们初步的单中心回顾性数据表明AC可能对重度TBI的治疗有益，并与更好的临床结果相关。这些有希望的结果需要更大的多中心临床研究进一步证实。胸水吻合术的潜在好处不应该鼓励没有手术技能的外科医生在水疗中心的创伤护理中心普遍实施。对颅骨外科医生进行颅底和血管外科手术技术的培训将避免与这种精密手术相关的潜在并发症。胸水吻合术的潜在好处不应该鼓励没有手术技能的外科医生在水疗中心的创伤护理中心普遍实施。对颅骨外科医生进行颅底和血管外科手术技术的培训将避免与这种精密手术相关的潜在并发症。胸水吻合术的潜在好处不应该鼓励没有手术技能的外科医生在水疗中心的创伤护理中心普遍实施。对颅骨外科医生进行颅底和血管外科手术技术的培训将避免与这种精密手术相关的潜在并发症。