Influence of lamina terminalis fenestration on the occurrence of the shunt-dependent hydrocephalus in anterior communicating artery aneurysmal subarachnoid hemorrhage.
Recently, it was reported that fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal subarachnoid hemorrhage (SAH). The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus in the ruptured anterior communicating artery (ACoA) aneurysms. The data of 71-ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. Group I (n=36) included the patients with microsurgical fenestration of LT during surgery, Group II (n=35) consisted of patients in whom fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factors. Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 patients (25.4%). The conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. However, there was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms because of the microsurgical fenestration of LT can play a negative role in reducing the incidence of chronic hydrocephalus.
Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea. kjm2323@hanyang.ac.kr
Jae Min
JM
Kim
Ji Young
JY
Jeon
Jae Hoon
JH
Kim
Jin Hwan
JH
Cheong
Koang Hum
KH
Bak
Choong Hyun
CH
Kim
Hyeong Joong
HJ
Yi
Kwang Myung
KM
Kim
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000517:prevention & control*; D007031:Hypothalamus / Q000601:surgery; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*