{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T18:41:41Z","timestamp":1793472101610,"version":"4.5.0"},"reference-count":113,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T00:00:00Z","timestamp":1699660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Aneurysmal subarachnoid hemorrhage (aSAH) provokes a cascade reaction that is responsible for early and delayed brain injuries mediated by intracranial hypertension, hydrocephalus, cerebral vasospasm (CV), and delayed cerebral ischemia (DCI), which result in increased morbidity and mortality. During open microsurgical repair, cisternal access is achieved essentially to gain proximal vascular control and aneurysm exposition. Cisternostomy also allows brain relaxation, removal of cisternal clots, and restoration of the CSF dynamics through the communication between the anterior and posterior circulation cisterns and the ventricular system, with the opening of the Membrane of Liliequist and lamina terminalis, respectively. Continuous postoperative CSF drainage through a cisternal drain (CD) is a valuable option for treating acute hydrocephalus and intracranial hypertension. Moreover, it efficiently removes the blood and toxic degradation products, with a potential benefit on CV, DCI, and shunt-dependent hydrocephalus. Finally, the CD is an effective pathway to administer vasoactive, fibrinolytic, and anti-oxidant agents and shows promising results in decreasing CV and DCI rates while minimizing systemic effects. We performed a comprehensive review to establish the adjuvant role of cisternostomy and CD performed in cases of direct surgical repair for ruptured intracranial aneurysms and their role in the prevention and treatment of aSAH complications.<\/jats:p>","DOI":"10.3390\/brainsci13111580","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T02:02:42Z","timestamp":1699840962000},"page":"1580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The Role of Cisternostomy and Cisternal Drainage in the Treatment of Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5586-0695","authenticated-orcid":false,"given":"Alberto","family":"Vandenbulcke","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4975-8237","authenticated-orcid":false,"given":"Mahmoud","family":"Messerer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy T.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0913-8965","authenticated-orcid":false,"given":"Giulia","family":"Cossu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of Lausanne (CHUV), University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S1474-4422(09)70126-7","article-title":"Changes in Case Fatality of Aneurysmal Subarachnoid Haemorrhage over Time, According to Age, Sex, and Region: A Meta-Analysis","volume":"8","author":"Nieuwkamp","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E314","DOI":"10.1161\/STR.0000000000000436","article-title":"2023 Guideline for the Management of Patients with Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association\/American Stroke Association","volume":"54","author":"Hoh","year":"2023","journal-title":"Stroke"},{"key":"ref_3","first-page":"e519","article-title":"Cognitive and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage","volume":"41","author":"Schweizer","year":"2010","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1227\/01.NEU.0000359317.15269.20","article-title":"Predictors of Global Cognitive Impairment 1 Year after Subarachnoid Hemorrhage","volume":"65","author":"Springer","year":"2009","journal-title":"Neurosurgery"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/01376517-200206000-00006","article-title":"The Impact of Aneurysmal Subarachnoid Hemorrhage on Functional Outcome","volume":"34","author":"Kirkness","year":"2002","journal-title":"J. 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