A Comparative Study to Analyse the Effectiveness of Basal Cisternostomy and Its Impact on the Outcome of Moderate and Severe Head Injury Patients.

Abstract

Background:

Severe traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide, often resulting in raised intracranial pressure (ICP) and secondary brain injury. While decompressive craniectomy (DC) remains the standard surgical option to relieve ICP, basal cisternostomy (BC) has emerged as a potential alternative aimed at restoring cerebrospinal fluid (CSF) dynamics and improving outcomes. This study compares the effectiveness and outcomes of basal cisternostomy versus decompressive craniectomy in patients with moderate and severe TBI.

Materials and Methods:

A prospective randomized controlled trial was conducted at SRM Medical College Hospital, Chennai, from December 2022 to December 2023. Fifty patients aged 18–65 years with moderate or severe TBI were randomly assigned to the basal cisternostomy group (n=25) or the decompressive craniectomy group (n=25). Demographic data, Glasgow Coma Scale (GCS), Marshall CT score, and postoperative variables including duration of ventilation, ICU stay, hospital stay, complications, and Glasgow Outcome Scale (GOS) at 3 months were recorded and statistically analyzed using IBM SPSS 20.0.

Results:

The mean postoperative GOS was significantly higher in the BC group (3.44 ± 1.50) compared with the DC group (2.68 ± 1.72; p = 0.010). Mortality was lower in the BC group (20%) than in the decompressive craniectomy group (44%). Patients undergoing basal cisternostomy required shorter ventilator support and ICU stay. Those with severe TBI (GCS < 9) showed better outcomes in the BC group (p = 0.02).

Conclusion:

Basal cisternostomy offers improved functional outcomes and lower mortality compared with decompressive craniectomy in moderate and severe Head injury. However, larger multicenter trials are needed to validate its long-term efficacy and feasibility.