Wentrykulocysternostomia – czynnikiem zapobiegawczym w powstawaniu przewlekłego wodogłowia u pacjentów z krwawieniem podpajęczynówkowym z pękniętego tętniaka śródczaszkowego
Title: Anterior ventriculostomy – is it a factor reducing the rate of shunt-dependent chronic hydrocephalus following aneurysmal subarachnoid hemorrhage?
Aim: Shunt-dependent chronic hydrocephalus (SDCH) is a common complication after aneurysmal subarachnoid hemorrhage (SAH). There are suggestions that fenestration of the lamina terminalis (LT) can significantly decrease the incidence of the above complication. The aim of this study was to compare retrospectively the incidence of SDCH between patients with and without LT fenestration as well as to explore the impact of other potential factors on the risk of hydrocephalus.
Material and methods: 337 patients with diagnosed aneurysmal SAH were surgically treated between years 1999 and 2001. The majority (262; 77.7%) had fenestration of LT, when in 75 cases (22.3%) aneurysm clipping was not followed by ventriculostomy.
Results: A total of 20 patients (5.9%) experienced hydrocephalus after SAH, whereas 14 of them were admitted in III or IV Hunt-Hess grade. There were significant differences in SDCH occurrence between patients treated with and without fenestration of LT. Apart from ventriculostomy, Fisher grade III/IV and aneurysm originating at the posterior communicant artery were significant risk factors for SDCH development.
Conclusion: Fenestration of LT is associated with decreased incidence of SDCH. For further clarification of that issue, a prospective and randomized study is needed. The preventive role of ventriculostomy via LT is still unexplored and a definite subgroup of SAH patients to whom this maneuver should be addressed is still unknown.
Autor: dr n. med. Mirosław Stempniewicz
Katedra i Klinika Neurochirurgii GUMed
ul Smoluchowskiego 17, Gdańsk