Association between Lamina Terminalis Fenestration and Shunt-Dependent Chronic Hydrocephalus After Ruptured Anterior Circulation Aneurysms: A Single-Center Retrospective Cohort Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage increases long-term morbidity. This study evaluated the association between lamina terminalis fenestration (LTF) during microsurgical clipping of ruptured anterior circulation aneurysms and shunt-dependent chronic hydrocephalus. Methods Patients who underwent craniotomy and microsurgical clipping between January 2016 and February 2023 were retrospectively reviewed. Patients who died within 14 days were excluded because of substantial comorbidity, coagulation disorders, multiorgan failure, or high mortality. Patients were grouped according to LTF status. The primary outcome was permanent ventriculoperitoneal shunt placement. The risk difference (RD), relative risk (RR), and odds ratio (OR) were calculated. Logistic regression models adjusted for aneurysm location and expanded exploratory models were constructed. The sensitivity analyses included patients with anterior communicating artery (ACom) aneurysms and survivors. Results Among the 138 patients, 48 (34.8%) underwent LTF, and 19 (13.8%) developed shunt-dependent hydrocephalus. The shunt rates were 16.7% (8/48) with LTF and 12.2% (11/90) without LTF (RD, 4.4 percentage points; 95% CI, − 8.1–17.0; RR = 1.36; 95% CI, 0.59–3.16; OR = 1.44; 95% CI, 0.54–3.85; p = 0.605). ACom aneurysms constituted 87.5% and 15.6% of the cases in the LTF and non-LTF groups, respectively (p < 0.001). LTF remained nonsignificant after adjustment for ACom location (OR = 0.68; 95% CI, 0.18–2.56; p = 0.569) and in the expanded model (OR = 0.76; 95% CI, 0.20–2.95; p = 0.690). Sensitivity analyses were also nonsignificant for ACom aneurysms (RR = 0.58; 95% CI, 0.20–1.70; p = 0.439) and survivors (RR = 1.31; 95% CI, 0.47–3.68; p = 0.751). Conclusion No significant association was found between LTF and shunt dependency. Limited events, wide confidence intervals, strong anatomical selection bias, and exclusion of early deaths limit certainty; therefore, these findings indicate that an independent association could not be established rather than conclusively demonstrating ineffectiveness.
Source: Research Square
Institution: Cukurova University
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7207628189