Microsurgical fenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

Ricardo J Komotar, Alessandro Olivi, Daniele Rigamonti, Rafael J. Tamargo, E. Sander Connolly, Daniel L. Barrow, Michael T. Lawton, J. Max Findlay

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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 languageEnglish
Pages (from-to)1403-1413
Number of pages11
JournalNeurosurgery
Volume51
Issue number6
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

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Subarachnoid Hemorrhage
Hydrocephalus
Hypothalamus
Incidence
Microsurgery
Craniotomy
Aneurysm
Neurosurgeons
Logistic Models
Odds Ratio
Regression Analysis

Keywords

  • Aneurysm
  • Fenestration
  • Hydrocephalus
  • Lamina terminalis
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Microsurgical fenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. / Komotar, Ricardo J; Olivi, Alessandro; Rigamonti, Daniele; Tamargo, Rafael J.; Connolly, E. Sander; Barrow, Daniel L.; Lawton, Michael T.; Findlay, J. Max.

In: Neurosurgery, Vol. 51, No. 6, 01.12.2002, p. 1403-1413.

Research output: Contribution to journalArticle

Komotar, Ricardo J ; Olivi, Alessandro ; Rigamonti, Daniele ; Tamargo, Rafael J. ; Connolly, E. Sander ; Barrow, Daniel L. ; Lawton, Michael T. ; Findlay, J. Max. / Microsurgical fenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. In: Neurosurgery. 2002 ; Vol. 51, No. 6. pp. 1403-1413.
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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.",
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AU - Komotar, Ricardo J

AU - Olivi, Alessandro

AU - Rigamonti, Daniele

AU - Tamargo, Rafael J.

AU - Connolly, E. Sander

AU - Barrow, Daniel L.

AU - Lawton, Michael T.

AU - Findlay, J. Max

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N2 - 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.

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KW - Aneurysm

KW - Fenestration

KW - Hydrocephalus

KW - Lamina terminalis

KW - Subarachnoid hemorrhage

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