J Korean Med Sci.  2006 Feb;21(1):113-118. 10.3346/jkms.2006.21.1.113.

Influence of Lamina Terminalis Fenestration on the Occurrence of the Shunt-Dependent Hydrocephalus in Anterior Communicating Artery Aneurysmal Subarachnoid Hemorrhage

• Kim JM
• Jeon JY
• Kim JH
• Cheong JH
• Bak KH
• Kim CH
• Yi HJ
• Kim KM

• KMID: 2157793
• DOI: http://doi.org/10.3346/jkms.2006.21.1.113

Abstract

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.

Keyword

Hydrocephalus; Chronic; Ventriculostomy; Hypothalamus; Lamina Terminalis; Intracranial Aneurysm; Anterior Communicating Artery; Circle of Willis; Subarachnoid Hemorrhage

MeSH Terms

Adult
Aged
Female
Humans
Hydrocephalus/etiology/*prevention & control
Hypothalamus/surgery
Intracranial Aneurysm/complications/*surgery
Male
Microsurgery/*methods
Middle Aged
Retrospective Studies
Subarachnoid Hemorrhage/etiology/*surgery
Treatment Outcome
Ventriculoperitoneal Shunt/*methods

Figure

• 

  Fig. 1 Graphs showing the distribution of patients according to variable factors. (A) Fisher grade is unexpectedly higher in Group II, and it has not statistical significance (p=0.2997; OR=0.5242). (B) Preoperative hydrocephalus and lamina terminalis (LT) fenestration is significantly associated (p=0.0287; OR=3.176). (C) In Group I, intraoperative ventriculostomy is performed in almost all cases as a routine procedure (p=<0.0001; OR=24.500).

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