title: Hypothalamic dysfunctions as a late consequence of surgical opening of the lamina terminalis. A controversial hypothesis.
abstract: BACKGROUND
  Opening of the lamina terminalis is often used in surgery of the optico-chiasmatic region. Consequently, alteration of cerebral-spinal fluid (CSF) dynamics can occur after this manoeuvre, thus potentially translating into clinical complications. Herein, we describe 2 cases in which clinically relevant hypothalamic dysfunctions developed after few days opening of the lamina terminalis both patients showed mild to moderate preoperative hydrocephalus which improved postoperatively.
  
  
  METHODS
  In a patient with ruptured aneurysm of the basilar bifurcation, opening of the lamina terminalis was performed prior to acute-stage clipping. On postoperative day 7th, the patient developed significant subdural hygroma, mild disturbances of consciousness and increase of ADH concentration. These clinical features resolved only following subdural hygroma drainage and ventricular-peritoneal shunting. One previously operated patient in whom the lamina terminalis had been opened to remove a sizeable parasellar tumour showed a similar post-operative course. In this patient, sole subdural hygroma drainage was not an effective treatment, and the patient died subsequently for complications related to long-standing, though mild, hypothalamic dysfunction.
  
  
  CONCLUSIONS
  Our experience may suggest that hypothalamic dysfunctions should be reminded as a possible, although rare, complication following the opening of the lamina terminalis. This clinical condition, if not properly managed, may contribute to trigger severe life-threatening complications.
authors.affiliation: Section of Neurosurgery, Department of Clinical Neurosciences, Neurological Centre of Latium NCL, Rome, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Spallone
authors.forename: Chiara
authors.initials: C
authors.lastname: Izzo
authors.forename: Cristiano
authors.initials: C
authors.lastname: Giannone
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery; D007027:Hypothalamic Diseases / Q000175:diagnosis / Q000209:etiology*; D007031:Hypothalamus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D013353:Subdural Effusion / Q000175:diagnosis / Q000601:surgery*