Abstract
OBJECTIVE: Hydrocephalus requiring shunt placement is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). Previous investigations suggest that fenestration of the lamina terminalis during microsurgery for aSAH may be associated with a reduced rate of shunt-dependent hydrocephalus. We report a retrospective analysis correlating fenestration of the lamina terminalis with decreased shunt-dependent hydrocephalus after aSAH. METHODS: During the past decade, 582 patients were admitted to our institution with aSAH. We compared the rate of shunting in patients operated on by a neurosurgeon ("index neurosurgeon") who routinely fenestrated the lamina terminalis (>98% of his patients) with that in patients managed by 14 other neurosurgeons who rarely fenestrated the lamina terminalis (<5% of their patients) and by 6 interventional neuroradiologists. The total cohort was subdivided into two groups on the basis of surgical approach and microsurgical access to the lamina terminalis. Group A included frontosphenotemporal craniotomies, an approach in which the lamina terminalis is accessible, and Group B included other approaches in which the lamina terminalis is not accessible. Shunting rates of the index neurosurgeon and those of the other practitioners were compared within Groups A and B. Shunting rates were compared by logistic regression and multivariable analysis. This study design isolates the effect of fenestrating the lamina terminalis on the incidence of shunt-dependent hydrocephalus. RESULTS: In Group A, the index neurosurgeon had a significantly lower rate of shunting, 2.3%, versus 12.6% for other practitioners (P = 0.011; odds ratio, 0.15). In Group B, in which the approach did not allow microsurgical fenestration of the lamina terminalis, there was no difference (P = 0.789) in the rate of shunting between the index neurosurgeon (10.0%) and other practitioners (13.2%). CONCLUSION: Fenestration of the lamina terminalis appears to be associated with a decreased incidence of shunt-dependent hydrocephalus of more than 80% after aSAH. This straightforward microsurgical maneuver should be performed whenever possible during aneurysm surgery.
Original language | English (US) |
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Pages (from-to) | 1403-1413 |
Number of pages | 11 |
Journal | Neurosurgery |
Volume | 51 |
Issue number | 6 |
DOIs | |
State | Published - Dec 1 2002 |
Externally published | Yes |
Keywords
- Aneurysm
- Fenestration
- Hydrocephalus
- Lamina terminalis
- Subarachnoid hemorrhage
ASJC Scopus subject areas
- Surgery
- Clinical Neurology