The effectivity and safety of cisternostomy and decompressive craniectomy as management of brain trauma: a systematic review and meta-analysis

Introduction: Traumatic brain injury (TBI) is the disease that causes the most common disability globally. The cisternostomy as adjuvant management of TBI lacks documentation. We aim to prove the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury. Methods: The search for published scientific articles using the Preferred Reporting, Items for Systematic Reviews, and Meta-Analysis (PRISMA) method. The search was conducted using the PubMed, Cochrane library, and Medline databases published in English for the last ten years until June 2022, evaluating the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury. The Oxford Center for Evidence-based medicine assessed the evidence levels of each study. Data analysis with RevMan version 5.3. Results: Four studies were included in this meta-analysis, two RCTs, and two observational studies. We find a total of 1000 patients with; 596 cisternostomies and 404 decompressive craniectomies. These primary points show that mean GOS at six weeks is 0.93 (I2:52%; 95%CI: 0.70 to 1.17; p<0,01), decrease in intracranial pressure post-operation is -3.20 mmHg (I2:97%; 95%CI: -3.84 to -2.56; p<0,01), duration of ICU stay is -2.37 days (I2:37%; 95%CI: -4.54 to -0.21; p<0,03), and mortality is 0.51 (I2:21%; 95%CI: 0.42 to 0.63; p<0,01). Conclusion: Cisternostomy is a beneficial procedure in TBI, leading to survival benefits and better clinical outcomes. Hopefully, more studies will examine its role in TBI patients critically in the future.