Parthiban Jutty K B C, Sundaramahalingam Shanthanam, Rao J Balaparameswara, Nannaware Vaishali Pralhad, Rathwa Vishnu Najarubhai, Nasre Vaibhav Yogesh, Prahlad Shantigrama Thirumalachar
Senior Consultant and HOD, Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India.
Senior Registrar, Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India.
Neurol India. 2021 Mar-Apr;69(2):328-333. doi: 10.4103/0028-3886.314535.
Decompressive craniectomy (DC) is considered the gold standard blanket surgical procedure for all medically intractable cerebral oedema in Traumatic Brain Injury (TBI). It's only proven fact is that it reduces Intra Cerebral Pressure (ICP) by providing space for the oedematous brain. Attempts are being made to find additional or alternative procedures to improve outcomes in TBI. Basal Cisternostomy is one such technique proposed to bring such a change in world literature.
To analyse the validity of Basal Cisternostomy in TBI patients.
A total of 40 patients who underwent Basal Cisternostomy (BC) in TBI admitted in the senior author's unit between January 2016 and April 2019 were analysed retrospectively. All surgeries were performed by single surgeon with microsurgical expertise. Outcome was assessed according to Glasgow outcome scale (GOS). Results were analysed using SPSS software.
In severe TBI, Basal Cisternostomy group showed 77.8% favourable outcome while Decompressive Craniectomy in addition to Basal Cisternostomy group showed 72.7% only. While favourable GOS was seen in 82% (33/40), the unfavourable outcome was noticed in 12.5% (5/40) and death in 5% (2/40) in this series. Hydrocephalus was seen in 12.5% (5/40). Patients operated earlier from the time of injury showed better results than those who got operated later irrespective of severity of neurological status. ICU stay and hospital stay duration and its validity could not be assessed.
Basal Cisternostomy is an effective procedure in Traumatic Brain Injury patients that not only improves outcome but also reduces the need for Decompressive Craniectomy as a blanket procedure and thus avoiding its associated complications.
去骨瓣减压术（DC）被认为是治疗创伤性脑损伤（TBI）中所有药物治疗无效的脑水肿的金标准全面性外科手术。其唯一已被证实的事实是，它通过为水肿的大脑提供空间来降低颅内压（ICP）。人们正在尝试寻找其他或替代手术方法以改善TBI的治疗效果。基底池造瘘术就是世界文献中提出的一种有望带来这种改变的技术。
分析基底池造瘘术在TBI患者中的有效性。
回顾性分析2016年1月至2019年4月在资深作者所在科室接受基底池造瘘术（BC）的40例TBI患者。所有手术均由一位具有显微外科专业知识的外科医生进行。根据格拉斯哥预后量表（GOS）评估预后。使用SPSS软件分析结果。
在重度TBI中，基底池造瘘术组显示77.8%的良好预后，而除基底池造瘘术外还进行去骨瓣减压术的组仅显示72.7%的良好预后。在本系列中，82%（33/40）患者预后良好，12.5%（5/40）患者预后不良，5%（2/40）患者死亡。12.5%（5/40）患者出现脑积水。受伤后早期接受手术的患者比晚期接受手术的患者效果更好，无论神经状态的严重程度如何。无法评估重症监护病房停留时间和住院时间及其有效性。
基底池造瘘术是治疗TBI患者的有效方法，不仅能改善预后，还能减少作为全面性手术的去骨瓣减压术的需求，从而避免其相关并发症。
