Basal cisternostomy for severe traumatic brain injury: illustrative case

Area of Science:

• Neurosurgery
• Trauma Care
• Critical Care Medicine

Background:

• Basal cisternostomy (BC) is gaining traction for intracranial pressure (ICP) management in severe traumatic brain injury (TBI).
• It is employed as an adjunct to decompressive craniectomy (DC) or as a standalone procedure.
• Regions like India and China are increasingly using BC, with emerging research supporting its efficacy.

Purpose of the Study:

• To present a case study on the application of Basal cisternostomy (BC) in severe traumatic brain injury (TBI).
• To highlight the potential of BC as an alternative or adjunct to traditional methods like decompressive craniectomy (DC).

Main Methods:

• A 17-year-old male with severe TBI (GCS 5, dilated pupils) presented with acute subdural hematoma (ASDH), midline shift, and brainstem compression.
• Emergency Basal cisternostomy (BC) was performed, followed by ASDH evacuation and bone flap replacement.
• Postoperative management focused on recovery and neurological assessment.

Main Results:

• The patient demonstrated a remarkable recovery post-BC and ASDH evacuation.
• Extubation occurred on day 2, with early mobilization achieved by day 7.
• At discharge on day 13, only mild word-finding difficulty persisted, showing significant improvement at follow-up.

Conclusions:

• Basal cisternostomy (BC) shows potential as an effective treatment for severe TBI, offering an alternative or adjunct to decompressive craniectomy (DC).
• Further validation through larger, multicenter studies is warranted to confirm the efficacy of BC in TBI management.
• This case underscores the clinical utility of BC in managing complex intracranial pathologies.