Cisternostomy for Refractory Posttraumatic Intracranial Hypertension.

The current surgical treatment of choice for refractory intracranial hypertension after traumatic brain injury (TBI) is decompressive craniectomy. Despite efficacy in control of intracranial pressure (ICP), its contribution to an improved outcome is debatable. We describe a case of refractory intracranial hypertension successfully managed with cisternostomy. The rationale for this surgical technique is discussed, with a focus on the pathophysiologic processes underlying elevated ICP and its improvement after surgery. Cisternostomy proved to have an immediate effect in controlling ICP and improving brain oxygenation and metabolism