Cisternostomy: surgical technique and technical nuances in the management of intracranial hypertension

Abstract

Cisternostomy is a microsurgical strategy aimed at lowering intracranial pressure (ICP) by re-establishing cerebrospinal fluid (CSF) communication across basal cisterns. In contrast to decompressive craniectomy, it achieves effective relaxation of the brain while preserving the calvarium. Over the past decade, growing clinical data have supported its use in traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). This article provides a detailed, stepwise description of the operative technique, emphasises key anatomical landmarks, and highlights practical nuances that improve safety and completeness of decompression.