Efficacy of lamina terminalis fenestration in reducing shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage: a systematic review

Abstract

This systematic review revealed no significant association between lamina terminalis fenestration and a reduced incidence of shunt-dependent hydrocephalus. The interpretation of these results, however, is restricted by unmatched cohort differences as well as other inherent study limitations. Although the overall literature supports lamina terminalis fenestration, a number of authors have questioned the technique's benefits, thus rendering its efficacy in reducing shunt-dependent hydrocephalus unclear. A well-designed, multicenter, randomized controlled trial is needed to definitively address the efficacy of this microsurgical technique.

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank

“…[3][4][5][6][7]11,12,16,18,23 On the basis of the evidence of an association between the severity of SAH and the prevalence of subsequent sNPH, many neurosurgeons have believed that several surgical manipulations for facilitating CSF dynamics, such as hematoma evacuation, widening the opening of the cisterns, and fenestration of the lamina terminalis, might help to reduce the subsequent occurrence of sNPH after the surgical treatment of SAH. However, the authors of a recent meta-analysis of 11 nonrandomized studies in which data from 1973 patients were pooled concluded that there was no significant difference in the prevalence of sNPH between the 975 patients who had undergone fenestration of the lamina terminalis and the 998 who had not (p = 0.09).…”

“…However, the authors of a recent meta-analysis of 11 nonrandomized studies in which data from 1973 patients were pooled concluded that there was no significant difference in the prevalence of sNPH between the 975 patients who had undergone fenestration of the lamina terminalis and the 998 who had not (p = 0.09). 11 On the basis of this evidence, guidelines for the management of chronic hydrocephalus after aneurysmal SAH from the American Heart Association recommend that fenestration of the lamina terminalis not be routinely performed. 2 Another meta-analysis of 5 nonrandomized studies with data from 1718 patients pooled 3 reported that 1336 patients treated with microsurgical clipping had a significantly lower risk of sNPH than 382 patients treated with endovascular coiling (relative risk 0.74; 95% CI 0.58-0.94; p = 0.01); however, 3 of the 5 studies found no significant difference between clipping and coiling for the predictive risk of sNPH.…”

“…[3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH. [3][4][5][6][7][8][9][10][11]12,16,18,23 A posterior circulation location of the ruptured aneurysm and endovascular coil embolization have been reported to be significantly associated with sNPH. 1,[4][5][6][7]12,15,16,22 However, this relationship is controversial, because SAH caused by a posterior circulation aneurysm frequently occurs with severe initial symptoms and acute hydrocephalus, compared to SAH caused by a ruptured anterior circulation aneurysm, which is known to occur with mild symptoms and/or no acute hydrocephalus.…”

“…The prevalence of sNPH has been reported to be 8.9%-48% in patients with SAH. [1][2][3][4][5][6][7]11,12,16,18,22,23 Acute hydrocephalus coexisting with SAH is known to be one of the most important predictors for sNPH. [3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH.…”

“…[1][2][3][4][5][6][7]11,12,16,18,22,23 Acute hydrocephalus coexisting with SAH is known to be one of the most important predictors for sNPH. [3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH. [3][4][5][6][7][8][9][10][11]12,16,18,23 A posterior circulation location of the ruptured aneurysm and endovascular coil embolization have been reported to be significantly associated with sNPH.…”