Lamina Terminalis Fenestration in Ruptured Anterior Circulation Aneurysm for Hydrocephalus - The Limitations

ABSTRACT

Aim: The aim of the study is to analyze the usefulness of lamina terminalis fenestration (LTF) in hydrocephalus secondary tosubarachnoid hemorrhage while performing surgical interventions for anterior circulation aneurysm and to know the limitationsof this procedure in patients who undergo clipping of these aneurysms.Materials and Methods: A total of 81 aneurysms in 78 patients were included in this study from the year 2001 to 2018. Patientsin the age range of 12–80 years were included. Male-female ratio was 11.1. Until February 2011, LTF was done for 9 patientswho had any degree of hydrocephalus as an adjuvant to clipping of the anterior circulation aneurysms. After March 2011, insteadof LTF, intraoperative ventricular tapping was done in patients with hydrocephalus.Results: Among the 9 cases who had undergone LTF, two patients developed frontoparietal subdural hygromas with masseffect. From March 2011 till date after stopping LTF, only 2 of 47 patients required ventriculoperitoneal shunt who ultimatelydeveloped chronic hydrocephalus.Conclusion: LTF can lead to potential complications such as subdural hygromas due to poor absorption in blood cloggedsubarachnoid spaces. This procedure must be adopted with caution as it has its own limitations.