Fenestration of Lamina Terminalis During Anterior Circulation Aneurysm Clipping on Occurrence of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Meta-Analysis

Mao, Jinning; Zhu, Qing; Ma, Ying; Lan, Qing; Yuan, Chao; Liu, Guodong

doi:10.1016/j.wneu.2019.01.270

Cited by 13 publications

(8 citation statements)

References 16 publications

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“…[ 22 ] The effect of lamina terminalis fenestration on reducing the incidence of development of chronic hydrocephalus after aSAH has been supported by some reports and refused by others . [ 3 , 5 , 12 , 16 , 22 , 29 , 44 ]…”

Section: Discussionmentioning

confidence: 99%

“…Reviewing the literature regarding the histopathological basis[ 8 , 21 , 51 ], clinical and radiological predictors[ 11 , 15 , 18 , 19 , 30 , 33 , 36 , 41 , 47 ] of chronic hydrocephalus after aSAH suggest that the disease is complex and multifactorial requiring innovations to prevent and treat hydrocephalus without resorting to CSF shunting. Although there have been some reports suggesting that some drugs as cilostazol[ 31 ] or some surgical maneuvers as fenestration of lamina terminalis[ 5 , 22 , 29 ] or tandem fenestration of lamina terminalis and Lilliquist membrane[ 3 , 42 ] can reduce the development chronic shunt-dependent hydrocephalus after aSAH, the situation is still challenging. We believe that some extra few minute consuming steps, during open microsurgical clipping, to reduce the clot burden and to accelerate drainage of subarachnoid blood products, could decrease the rate of chronic shunt-dependent hydrocephalus after aSAH without exposing the patients to more complications.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of development of chronic hydrocephalus after aSAH was affected by treatment modality used to secure the ruptured aneurysm, whether microsurgical clipping or endovascular coiling, in some reports and not affected in other ones. [ 1 , 2 , 9 , 11 , 13 , 15 - 19 , 23 , 29 , 30 , 32 , 33 , 46 , 47 , 49 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 30 ] It was also suggested that fenestration of lamina terminalis during microsurgery for anterior circulation aneurysms decreases the incidence of chronic hydrocephalus and shunt dependence after aSAH. [ 29 ] The objective of our study was to evaluate whether external ventricular drainage through a catheter inserted into fenestrated lamina terminalis during microsurgery for clipping of ruptured anterior circulation aneurysms was associated with reduced rate of development of chronic hydrocephalus and shunt dependence.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy of translamina terminalis ventriculostomy tube in prevention of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage

Elsharkawy¹,

Abdelhameed²

2020

Surgical Neurology International

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Background: Chronic shunt-dependent hydrocephalus is still a common complication after aneurysmal SAH (aSAH) and is associated with increased morbidity. Pathology of chronic shunt-dependent hydrocephalus after aSAH is complex and multifactorial which makes its prevention challenging. We thought to evaluate whether external ventricular drainage (EVD) through fenestrated lamina terminalis would decrease the rate of chronic shunt-dependent hydrocephalus after aSAH. Methods: A retrospective analysis of 68 consecutive patients with aSAH who underwent microsurgical clipping of the ruptured aneurysm. Patients were divided into two groups: Group A included patients with lamina terminalis fenestration without insertion of ventriculostomy tube and Group B included patients with EVD through fenestrated lamina terminalis. Demographic, clinical, radiological, and outcome variables were compared between groups. Results: Group A comprised 29 patients with mean age of 47.8 years and Group B comprised 39 patients with mean age of 46.6 years. Group B patients had statistically significant (P < 0.05) lower incidence of chronic shunt- dependent hydrocephalus than Group A patients (30.8% vs. 55.2%, respectively). Conclusion: EVD through fenestrated lamina terminalis is safe and may be effective in decreasing the incidence of chronic shunt-dependent hydrocephalus after aSAH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of translamina terminalis ventriculostomy tube in prevention of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage

Elsharkawy¹,

Abdelhameed²

2020

Surgical Neurology International

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show abstract

“…It is common standard to occlude the culprit aneurysm by surgical clipping or endovascular coiling within 24 to 48 hours after hemorrhage, with coiling being preferred if both methods are equally feasible . Efforts to remove the blood in the basal cisterns as the causative agent for vasospasm by surgery, cisternal, or external ventricular drainage showed mixed results . In retrospective studies, prophylactic lumbar drainage of cerebrospinal fluid was associated with favorable outcome .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Lumbar Cerebrospinal Fluid Drain Among Patients With Aneurysmal Subarachnoid Hemorrhage

Wolf,

Mielke,

Barner

et al. 2023

JAMA Neurol

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ImportanceAfter aneurysmal subarachnoid hemorrhage, the use of lumbar drains has been suggested to decrease the incidence of delayed cerebral ischemia and improve long-term outcome.ObjectiveTo determine the effectiveness of early lumbar cerebrospinal fluid drainage added to standard of care in patients after aneurysmal subarachnoid hemorrhage.Design, Setting, and ParticipantsThe EARLYDRAIN trial was a pragmatic, multicenter, parallel-group, open-label randomized clinical trial with blinded end point evaluation conducted at 19 centers in Germany, Switzerland, and Canada. The first patient entered January 31, 2011, and the last on January 24, 2016, after 307 randomizations. Follow-up was completed July 2016. Query and retrieval of data on missing items in the case report forms was completed in September 2020. A total of 20 randomizations were invalid, the main reason being lack of informed consent. No participants meeting all inclusion and exclusion criteria were excluded from the intention-to-treat analysis. Exclusion of patients was only performed in per-protocol sensitivity analysis. A total of 287 adult patients with acute aneurysmal subarachnoid hemorrhage of all clinical grades were analyzable. Aneurysm treatment with clipping or coiling was performed within 48 hours.InterventionA total of 144 patients were randomized to receive an additional lumbar drain after aneurysm treatment and 143 patients to standard of care only. Early lumbar drainage with 5 mL per hour was started within 72 hours of the subarachnoid hemorrhage.Main Outcomes and MeasuresPrimary outcome was the rate of unfavorable outcome, defined as modified Rankin Scale score of 3 to 6 (range, 0 to 6), obtained by masked assessors 6 months after hemorrhage.ResultsOf 287 included patients, 197 (68.6%) were female, and the median (IQR) age was 55 (48-63) years. Lumbar drainage started at a median (IQR) of day 2 (1-2) after aneurysmal subarachnoid hemorrhage. At 6 months, 47 patients (32.6%) in the lumbar drain group and 64 patients (44.8%) in the standard of care group had an unfavorable neurological outcome (risk ratio, 0.73; 95% CI, 0.52 to 0.98; absolute risk difference, −0.12; 95% CI, −0.23 to −0.01; P = .04). Patients treated with a lumbar drain had fewer secondary infarctions at discharge (41 patients [28.5%] vs 57 patients [39.9%]; risk ratio, 0.71; 95% CI, 0.49 to 0.99; absolute risk difference, −0.11; 95% CI, −0.22 to 0; P = .04).Conclusion and RelevanceIn this trial, prophylactic lumbar drainage after aneurysmal subarachnoid hemorrhage lessened the burden of secondary infarction and decreased the rate of unfavorable outcome at 6 months. These findings support the use of lumbar drains after aneurysmal subarachnoid hemorrhage.Trial RegistrationClinicalTrials.gov Identifier: NCT01258257

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CSF Physiology and Intracranial Pressure

Davies

Paff

Chen

et al. 2023

Skull Base Reconstruction

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Fenestration of Lamina Terminalis During Anterior Circulation Aneurysm Clipping on Occurrence of Shunt-Dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage: Meta-Analysis

Cited by 13 publications

References 16 publications

Efficacy of translamina terminalis ventriculostomy tube in prevention of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage

Efficacy of translamina terminalis ventriculostomy tube in prevention of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage

Effectiveness of Lumbar Cerebrospinal Fluid Drain Among Patients With Aneurysmal Subarachnoid Hemorrhage

CSF Physiology and Intracranial Pressure

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