Elevating Neurosurgical Standards in Traumatic Brain Injury: A High-Evidence Meta-Analysis of Basal Cisternostomy

Basal cisternostomy (BC) represents a crucial advancement in the management of traumatic brain injury (TBI) by directly addressing elevated intracranial pressure (ICP) from cerebral edema. While decompressive craniectomy (DC) is the standard treatment for lowering ICP, it does not specifically target cerebral edema. In contrast, BC improves cerebrospinal fluid (CSF) drainage, marking a significant step forward in TBI management. This high-evidence meta-analysis of randomized controlled trials (RCTs) on the combination of BC and DC in TBI is essential for optimizing universal standard surgical protocols. A systematic search was conducted in August 2024 in PubMed, Cochrane, and Science Direct following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Randomized control trials comparing DC with and without BC in moderate-to-severe TBI patients were included. Meta-analysis was performed using RevMan 5.4 (The Cochrane Collaboration) software to calculate pooled mean differences (MDs) or odds ratios (ORs) for outcomes (Glasgow Outcome Scale [GOS], intensive care unit [ICU] stay, mortality, and mechanical ventilation [MV] duration). The Cochrane RoB 2.0 (The Cochrane Collaboration) tool assessed the risk of bias in the included studies. Analysis of three RCTs showed that adding BC to DC significantly improved GOS outcomes (MD = 0.86; 95% CI [0.42–1.30], p = 0.0001), reduced ICU stay (MD = −3.87 days, 95% CI [−7.70 to −0.04]; p = 0.05), lowered mortality (OR = 0.54; 95% CI[0.30;0.97]; p = 0.04), and shortened MV support duration (MD = −3.77 days; 95% CI [−7.26 to −0.27];p = 0.03). Optimizing TBI surgery with BC integration significantly improves patient outcomes, underscoring its importance as a key enhancement to standard TBI surgery.