Cisternostomy Facilitates Clearance of Metabolic Waste from Cerebrospinal Fluid in Patients with Severe 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 patients with severe brain injury (SBI), has shown efficacy in reducing intracranial pressure and clearing detritus resulting from brain hemorrhage. However, the mechanisms underlying their effectiveness remain largely unknown. Here, we utilized non-targeted metabolomics to analyze cerebrospinal fluid (CSF) from cisterns alongside peripheral blood samples from SBI 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 early stage of SBI. 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 (GCS). Our findings indicate that cisternostomy effectively removes blood-derived substances and aids the recovery of patients with early-stage brain injury.