Abstract：
BACKGROUND: The Cisternostomy is a novel surgical concept in the treatment of Traumatic Brain Injury (TBI), which can effectively drain the bloody cerebrospinal fluid from the skull base cistern, reduce the intracranial pressure, and improve the return of bone flap, but its preventive role in post-traumatic hydrocephalus (PTH) is unknow. The purpose of this paper is to investigate whether Cisternostomy prevents the occurrence of PTH in patients with moderate and severe TBI.
METHODS: A retrospective analysis of clinical data of 86 patients with moderate and severe TBI from May 2019 to October 2021 was carried out in the Brain Trauma Center of Tianjin Huanhu Hospital. Univariate analysis was performed to examine the gender, age, preoperative Glasgow Coma Scale (GCS) score, preoperative Rotterdam CT score, decompressive craniectomy rate, intracranial infection rate, the incidence of subdural fluid, and incidence of hydrocephalus in patients between the Cisternostomy group and the non-Cisternostomy surgery group. we also analyzed the clinical outcome indicators like GCS at discharge,6 month GOS-E and GOS-E ≥ 5 in two groups.Additionaly, the preoperative GCS score, decompressive craniectomy rate, age, and gender of patients with PTH and non hydrocephalus were compared. Further multifactorial logistic binary regression was performed to explore the risk factors for PTH. Finally, we conducted ROC curve analysis on the statistically significant results from the univariate regression analysis to predict the ability of each risk factor to cause PTH.
RESULTS: The Cisternostomy group had a lower bone flap removal rate(48.39% and 72.73%, p = 0.024)., higer GCS at discharge(11.13 ± 2.42 and 8.93 ± 3.31,p = 0.000) and better 6 month GOS-E(4.55 ± 1.26 and 3.95 ± 1.18, p = 0.029)than the non-Cisternostomy group However, there was no statistical difference in the incidence of hydrocephalus between the two groups (25.81% and 30.91%, p = 0.617). Moreover, between the hydrocephalus group and no hydrocephalus group,there were no significant differences in the incidence of gender, age, intracranial infection, and subdural fluid. While there were statistical differences in peroperative GCS score, Rotterdam CT score, decompressive craniectomy rate, intracranial infection rate, and the incidence of subdural fluid in the two groups, there was no statistical difference in the percentage of cerebral cisterns open drainage between the hydrocephalus group and no hydrocephalus group (32.00% and 37.70%, p = 0.617). Multifactorial logistic binary regression analysis results revealed that the independent risk factors for PTH were intracranial infection (OR = 18.460, 95% CI: 1.864-182.847 p = 0.013) and subdural effusion (OR = 10.557, 95% CI: 2.425-35.275 p = 0.001). Further, The ROC curve analysis showed that peroperative GCS score, Rotterdam CT score and subdural effusion had good ACU(0.785,0.730,and 0.749), with high sensitivity and specificity to predict the occurrence of PTH.
CONCLUSIONS: Cisternostomy may decrease morbidities associated with removal of the bone flap and improve the clinical outcome, despite it cannot reduce the disability rate in TBI patients.Intracranial infection and subdural fluid were found to be the independent risk factors for PTH in patients with TBI,and the peroperative GCS score, Rotterdam CT score and subdural effusion had higher sensitivity and specificity to predict the occurrence of PTH. And more importantly, no correlation was observed between open drainage of the cerebral cisterns and the occurrence of PTH, indicating that Cisternostomy may not be beneficial in preventing the occurrence of PTH in patients with moderate and severe TBI.
METHODS: A retrospective analysis of clinical data of 86 patients with moderate and severe TBI from May 2019 to October 2021 was carried out in the Brain Trauma Center of Tianjin Huanhu Hospital. Univariate analysis was performed to examine the gender, age, preoperative Glasgow Coma Scale (GCS) score, preoperative Rotterdam CT score, decompressive craniectomy rate, intracranial infection rate, the incidence of subdural fluid, and incidence of hydrocephalus in patients between the Cisternostomy group and the non-Cisternostomy surgery group. we also analyzed the clinical outcome indicators like GCS at discharge,6 month GOS-E and GOS-E ≥ 5 in two groups.Additionaly, the preoperative GCS score, decompressive craniectomy rate, age, and gender of patients with PTH and non hydrocephalus were compared. Further multifactorial logistic binary regression was performed to explore the risk factors for PTH. Finally, we conducted ROC curve analysis on the statistically significant results from the univariate regression analysis to predict the ability of each risk factor to cause PTH.
RESULTS: The Cisternostomy group had a lower bone flap removal rate(48.39% and 72.73%, p = 0.024)., higer GCS at discharge(11.13 ± 2.42 and 8.93 ± 3.31,p = 0.000) and better 6 month GOS-E(4.55 ± 1.26 and 3.95 ± 1.18, p = 0.029)than the non-Cisternostomy group However, there was no statistical difference in the incidence of hydrocephalus between the two groups (25.81% and 30.91%, p = 0.617). Moreover, between the hydrocephalus group and no hydrocephalus group,there were no significant differences in the incidence of gender, age, intracranial infection, and subdural fluid. While there were statistical differences in peroperative GCS score, Rotterdam CT score, decompressive craniectomy rate, intracranial infection rate, and the incidence of subdural fluid in the two groups, there was no statistical difference in the percentage of cerebral cisterns open drainage between the hydrocephalus group and no hydrocephalus group (32.00% and 37.70%, p = 0.617). Multifactorial logistic binary regression analysis results revealed that the independent risk factors for PTH were intracranial infection (OR = 18.460, 95% CI: 1.864-182.847 p = 0.013) and subdural effusion (OR = 10.557, 95% CI: 2.425-35.275 p = 0.001). Further, The ROC curve analysis showed that peroperative GCS score, Rotterdam CT score and subdural effusion had good ACU(0.785,0.730,and 0.749), with high sensitivity and specificity to predict the occurrence of PTH.
CONCLUSIONS: Cisternostomy may decrease morbidities associated with removal of the bone flap and improve the clinical outcome, despite it cannot reduce the disability rate in TBI patients.Intracranial infection and subdural fluid were found to be the independent risk factors for PTH in patients with TBI,and the peroperative GCS score, Rotterdam CT score and subdural effusion had higher sensitivity and specificity to predict the occurrence of PTH. And more importantly, no correlation was observed between open drainage of the cerebral cisterns and the occurrence of PTH, indicating that Cisternostomy may not be beneficial in preventing the occurrence of PTH in patients with moderate and severe TBI.
摘要：
背景：在创伤性脑损伤（TBI）的治疗中，管道造瘘术是一种新颖的手术概念，可以有效地从颅底水箱中排出血性脑脊液，降低颅内压,改善骨瓣的复位，但其在创伤后脑积水（PTH）中的预防作用尚不清楚。目的探讨中重度TBI患者行胸壁造口术是否能预防PTH的发生。
方法：回顾性分析天津市环湖医院脑外伤中心2019年5月至2021年10月收治的86例中重度TBI患者的临床资料。进行单变量分析以检查性别，年龄,术前格拉斯哥昏迷量表(GCS)评分,术前鹿特丹CT评分,去骨瓣减压率,颅内感染率,硬膜下积液的发生率，和脑积水的发生率在胸壁造口术组和非胸壁造口术组之间。我们还分析了临床结局指标，如出院时的GCS，两组6个月GOS-E及GOS-E≥5。另外，术前GCS评分,去骨瓣减压率,年龄,比较PTH和非脑积水患者的性别。进一步进行多因素logistic二元回归以探讨PTH的危险因素。最后,我们对单因素回归分析的有统计学意义的结果进行ROC曲线分析,以预测各危险因素引起PTH的能力.
结果：胸壁造口组骨瓣切除率较低（48.39%和72.73%，p=0.024)。,出院时GCS较高（11.13±2.42和8.93±3.31，p=0.000），6个月GOS-E较好（4.55±1.26和3.95±1.18，p=0.029）。两组脑积水发生率差异无统计学意义(25.81%和30.91%,p=0.617)。此外，在脑积水组和非脑积水组之间，性别差异无统计学意义,年龄,颅内感染,和硬膜下液.虽然围手术期GCS评分有统计学差异,鹿特丹CT评分,去骨瓣减压率,颅内感染率,两组硬膜下积液的发生率，脑积水组和非脑积水组之间的脑池开放引流百分比无统计学差异（32.00％和37.70％，p=0.617)。多因素logistic二元回归分析结果显示,PTH的独立危险因素为颅内感染(OR=18.460,95%CI:1.864~182.847p=0.013)和硬膜下积液(OR=10.557,95%CI:2.425~35.275p=0.001)。Further,ROC曲线分析显示围手术期GCS评分,鹿特丹CT评分和硬膜下积液的ACU较好（0.785、0.730和0.749），对预测PTH的发生具有较高的敏感性和特异性。
结论：管间造口术可以减少与去除骨瓣相关的发病率，并改善临床结果。尽管它不能降低TBI患者的致残率。颅内感染和硬膜下积液是TBI患者发生PTH的独立危险因素。和围手术期GCS评分,鹿特丹CT评分和硬膜下积液对预测PTH的发生具有较高的敏感性和特异性。更重要的是,没有观察到脑池的开放引流和PTH的发生之间的相关性，这表明在中度和重度TBI患者中，Cisternostaline可能不利于预防PTH的发生。
方法：回顾性分析天津市环湖医院脑外伤中心2019年5月至2021年10月收治的86例中重度TBI患者的临床资料。进行单变量分析以检查性别，年龄,术前格拉斯哥昏迷量表(GCS)评分,术前鹿特丹CT评分,去骨瓣减压率,颅内感染率,硬膜下积液的发生率，和脑积水的发生率在胸壁造口术组和非胸壁造口术组之间。我们还分析了临床结局指标，如出院时的GCS，两组6个月GOS-E及GOS-E≥5。另外，术前GCS评分,去骨瓣减压率,年龄,比较PTH和非脑积水患者的性别。进一步进行多因素logistic二元回归以探讨PTH的危险因素。最后,我们对单因素回归分析的有统计学意义的结果进行ROC曲线分析,以预测各危险因素引起PTH的能力.
结果：胸壁造口组骨瓣切除率较低（48.39%和72.73%，p=0.024)。,出院时GCS较高（11.13±2.42和8.93±3.31，p=0.000），6个月GOS-E较好（4.55±1.26和3.95±1.18，p=0.029）。两组脑积水发生率差异无统计学意义(25.81%和30.91%,p=0.617)。此外，在脑积水组和非脑积水组之间，性别差异无统计学意义,年龄,颅内感染,和硬膜下液.虽然围手术期GCS评分有统计学差异,鹿特丹CT评分,去骨瓣减压率,颅内感染率,两组硬膜下积液的发生率，脑积水组和非脑积水组之间的脑池开放引流百分比无统计学差异（32.00％和37.70％，p=0.617)。多因素logistic二元回归分析结果显示,PTH的独立危险因素为颅内感染(OR=18.460,95%CI:1.864~182.847p=0.013)和硬膜下积液(OR=10.557,95%CI:2.425~35.275p=0.001)。Further,ROC曲线分析显示围手术期GCS评分,鹿特丹CT评分和硬膜下积液的ACU较好（0.785、0.730和0.749），对预测PTH的发生具有较高的敏感性和特异性。
结论：管间造口术可以减少与去除骨瓣相关的发病率，并改善临床结果。尽管它不能降低TBI患者的致残率。颅内感染和硬膜下积液是TBI患者发生PTH的独立危险因素。和围手术期GCS评分,鹿特丹CT评分和硬膜下积液对预测PTH的发生具有较高的敏感性和特异性。更重要的是,没有观察到脑池的开放引流和PTH的发生之间的相关性，这表明在中度和重度TBI患者中，Cisternostaline可能不利于预防PTH的发生。
