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This randomized trial evaluated whether adding basal cisternostomy to decompressive craniectomy improves outcomes in 50 patients undergoing emergency TBI surgery. Cisternal opening produced an additional 4.1 ± 2.8 mmHg reduction in ICP (P<0.001), but final intraoperative ICP was similar between ABC and DC groups (10.24 vs 9.35 mmHg; P=.387). Mean GOS-E at discharge was 3.40 vs 2.84 (P=.31), and at 6 months 4.08 vs 4.20 (P=.774), with favourable outcomes in 50% vs 52%. ABC increased operative time by 78 minutes (P<.001) and blood loss by 276 mL (P=.029). Hydrocephalus requiring diversion was lower with ABC (8% vs 24%), as was CSF leak (0% vs 12%), but unplanned reoperation was higher (24% vs 12%).
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This randomized trial evaluated whether adding basal cisternostomy to decompressive craniectomy improves outcomes in 50 patients undergoing emergency TBI surgery. Cisternal opening produced an additional 4.1 ± 2.8 mmHg reduction in ICP (P<0.001), but final intraoperative ICP was similar between ABC and DC groups (10.24 vs 9.35 mmHg; P=.387). Mean GOS-E at discharge was 3.40 vs 2.84 (P=.31), and at 6 months 4.08 vs 4.20 (P=.774), with favourable outcomes in 50% vs 52%. ABC increased operative time by 78 minutes (P<.001) and blood loss by 276 mL (P=.029). Hydrocephalus requiring diversion was lower with ABC (8% vs 24%), as was CSF leak (0% vs 12%), but unplanned reoperation was higher (24% vs 12%).
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