• Lorenzo Giammattei, Mahmoud Messerer, Iype Cherian, Daniele Starnoni, Rodolfo Maduri, Ekkehard M Kasper, and Roy T Daniel.
• Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: lorenzo.giammattei@chuv.ch.
• World Neurosurg. 2018 Aug 1; 116: 322-328.

BackgroundThe available surgical options to control increased intracranial pressure and to limit secondary brain damage in the setting of severe traumatic brain injury (TBI) include decompressive craniectomy, cisternostomy, and other methods to divert cerebrospinal fluid (CSF) such as placement of an external ventricular drain.MethodsWe discuss the rationale and the limitations of these surgical techniques based on preclinical and clinical evidence. A detailed description of the differences between ventricular CSF drainage and cisternal drainage is added based on recent hypotheses on TBI physiopathology and CSF circulation.ResultsCisternostomy seems a more physiological approach to the treatment of brain swelling, with the potential of effectively controlling intracranial pressure and reducing the effects of secondary brain damage.ConclusionsFurther clinical studies need to be performed to validate the efficacy of this emerging surgical procedure for severe TBI.Copyright © 2018 Elsevier Inc. All rights reserved.

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