Comparing the Therapeutic Effects of Cisternostomy versus Decompressive Craniectomy in the Management of Traumatic Brain Injury - Systematic Review and Meta-analysis Protocol

Background Traumatic brain injury (TBI) is a critical problem which portends an intensive burden with increased mortality and disability affecting more the young population worldwide. The primary goal of TBI treatment is to control intracranial pressure (ICP) and to prevent he devastating effect of secondary brain insult. For over a hundred years decompressive craniectomy has been a standard surgical intervention for treatment of TBI, however it is not without harm since it causes serious complications including meningitis, subdural hygroma, hydrocephalous and increased reoperation rate. Cisternostomy is the most recently introduced intervention for management of cerebral edema Cisternostomy has proven its efficiency a standalone treatment as an adjunctive to decompressive craniectomy in treatment of severe traumatic brain injury. This review aims at investigating the therapeutic effects of cisternostomy when used independently or as an adjunctive to decompressive craniectomy (DC) across the available randomized clinical trials (RCTs) and non randomized studies of effect intervention (NRSI) sectional studies to optimize the strength of evidence for underpinning the strategy for treatment of traumatic brain injury. Methods and Analysis We will conduct the systematic review and meta-analysis by employing the provisions of Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guideline and the review protocol has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) for registration before commencement of the study. We will construct the search strategy using the all field terms, medical subheading terms [MeSH Terms] with all permutations combined with Boolean operators such as AND and OR. PubMed, EMBASE, Scopus, COCHRAINE, Web Of Science, Global Index Medicus, Semantic Scholar and Google Scholar electronic databases will be searched. Ethical Consideration and Dissemination This review will not include any human participant such that the ethical clearance approval is not applicable. The protocol of this review has been registered at PROSPERO ID CRD42023400894. We will disseminate the final report of this review to local and international scientific conferences and The results of this review will be submitted for publication in the Journal of Neurotrauma. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Not applicable