Machine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zürich, 8091, Switzerland.
Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
Neurosurg Rev. 2024 Oct 2;47(1):717. doi: 10.1007/s10143-024-02954-4.
Basal cisternostomy (BC) is a surgical technique to reduce intracranial hypertension following moderate to severe traumatic brain injury (TBI). As the efficacy and safety of BC in patients with TBI has not been well-studied, we aim to summarize the published evidence on the effect of BC as an adjunct to decompressive hemicraniectomy (DHC) on clinical outcome following moderate to severe TBI.
A systematic literature review was carried out in PubMed/MEDLINE and EMBASE to identify studies evaluating BC as an adjunct to decompressive hemicraniectomy (DHC) in moderate to severe TBI. Random effects meta-analysis was performed to calculate summary effect estimates.
Eight studies reporting on 1345 patients were included in the qualitative analysis, of which five (1206 patients) were considered for meta-analysis. Overall, study quality was low and clinical heterogeneity was high. Adjuvant BC (BC + DHC) compared to standalone DHC was associated with a reduction in the length of stay in the ICU (Mean difference [MD]: -3.25 days, 95% CI: -5.41 to -1.09 days, p = 0.003), significantly lower mean brain outward herniation (MD: -0.68 cm, 95% CI: -0.90 to -0.46 cm, p < 0.001), reduced odds of requiring osmotherapy (OR: 0.09, 95% CI: 0.02 to 0.41, p = 0.002) as well as decreased odds of mortality at discharge (OR 0.68, 95% CI: 0.4 to 0.96, p = 0.03). Adjuvant BC compared to DHC did not result in higher odds of a favourable neurological outcome (OR = 2.50, 95% CI: 0.95-6.55, p = 0.06) and did not affect mortality at final follow-up (OR: 0.80, 95% CI: 0.17 to 3.74, p = 0.77).
There is insufficient data to demonstrate a potential beneficial effect of adjuvant BC. Despite some evidence for reduced mortality and length of stay, there is no effect on neurological outcome. However, these results need to be interpreted with caution as they carry a high risk of bias due to overall scarcity of published clinical data, technical variations, methodological differences, limited cohort sizes, and a considerable heterogeneity in study design and reported outcomes.
基底池造口术（BC）是一种降低中重度创伤性脑损伤（TBI）后颅内压的手术技术。由于 BC 治疗 TBI 的疗效和安全性尚未得到充分研究，我们旨在总结已发表的关于 BC 作为减压性半脑切除术（DHC）辅助手段对中重度 TBI 临床结果的影响的证据。
在 PubMed/MEDLINE 和 EMBASE 中进行了系统文献检索，以确定评估 BC 作为中重度 TBI 减压性半脑切除术（DHC）辅助手段的研究。采用随机效应荟萃分析计算汇总效应估计值。
纳入了 8 项研究，共报告了 1345 例患者，其中 5 项（1206 例患者）进行了荟萃分析。总体而言，研究质量较低，临床异质性较高。与单纯 DHC 相比，辅助性 BC（BC+DHC）可降低 ICU 住院时间（平均差值[MD]：-3.25 天，95%CI：-5.41 至-1.09 天，p=0.003），显著降低平均脑外凸（MD：-0.68cm，95%CI：-0.90 至-0.46cm，p<0.001），降低需要渗透压治疗的几率（OR：0.09，95%CI：0.02 至 0.41，p=0.002），降低出院时的死亡率（OR 0.68，95%CI：0.4 至 0.96，p=0.03）。与 DHC 相比，辅助性 BC 并未增加良好神经功能结局的几率（OR=2.50，95%CI：0.95-6.55，p=0.06），也不影响最终随访时的死亡率（OR：0.80，95%CI：0.17 至 3.74，p=0.77）。
目前尚无足够数据证明辅助性 BC 具有潜在的有益效果。尽管有一些证据表明死亡率和住院时间降低，但对神经功能结局没有影响。然而，由于发表的临床数据总体匮乏、技术差异、方法学差异、队列规模有限以及研究设计和报告结果的异质性较大，这些结果需要谨慎解释。
