Dissection of basal cisterns for treatment of severe traumatic brain injury

Abstract

Background. According to WHO, severe traumatic brain injury is among the top ten leading causes of death worldwide. Despite the centuries‑old history of development of the treatment methods to patients with traumatic brain injury their results according to large randomized studies remain unsatisfactory – mortality and severe disability are observed in more than 50 % of patients. Some experimental studies indicate that decompressive craniectomy can aggravate the severity of cerebral edema by creating conditions for traction of nerve fibers and can lead to hemorrhagic transformation of injury foci and ischemia. During the last decade, experimental studies and technological progress have significantly expanded the understanding of brain normal and pathological physiology and made it possible to develop new methods of surgical interventions. In particular, a number of publications have shown significant advantages of dissection of arachnoid spaces of brain base in case of severe traumatic brain injury as compared with classical decompressive craniectomy.Aim. To analyze the literature data on pathophysiological justification, surgery technique and results of dissection of arachnoid spaces of the brain base in case of severe traumatic brain injury as well as the advantages and disadvantages of the method as compared with standard treatment methods of such patients.Materials and methods. Literature search through in the main databases was carried out. The methods of opening of basal subarachnoid spaces in case of severe traumatic brain injury, pathophysiological justification and surgery techniques as well as results of clinical studies of the techniques employed are analyzed.Results. Information on pathogenesis of cerebral edema and pathophysiological justification of effectiveness of opening of brain base cisterns for treatment of traumatic brain injury, data on cisternostomy surgery technique and results were revealed, systematized and analyzed. Publications of individual clinical cases and series of observations indicate acceptable results of cisternostomy in comparison with decompressive craniectomy for treatment of traumatic brain injury.Conclusions. Dissection of arachnoid spaces of the brain base with perforation of the terminal plate and the Liliequist membrane is a promising method of surgical treatment of severe traumatic brain injury.