Cisternostomy facilitates clearance of metabolic waste from cerebrospinal fluid in patients with traumatic brain injury
Decompressive craniotomy, a common intervention for traumatic brain injury (TBI), can fail to effectively alleviate patient symptoms. Cisternostomy, reported for cistern drainage in TBI patients, has shown efficacy in reducing intracranial pressure and clearing detritus resulting from brain hemorrhage. However, the mechanisms underlying its effectiveness remain largely unknown. Here, we utilized non-targeted metabolomics to analyze cerebrospinal fluid from cisterns alongside peripheral blood samples from TBI patients undergoing cisternostomy. Through a systematic comparison of the cisternal cerebrospinal fluid and blood plasma metabolomes, we identified multiple blood-enriched metabolites, including betaine, triethanolamine, and proline, that were efficiently cleared during the acute stage of TBI. Notably, two metabolites linked to arginine metabolism and the urea cycle, N8-acetylspermidine and N-acetylputrescine, showed significant reductions that correlated with improvements in the Glasgow Coma Scale. Our findings indicate that cisternostomy effectively removes blood-derived substances and aids the recovery of patients with acute-stage TBI.