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

BACKGROUND: Shunt-dependent hydrocephalus (SDH) is a common complication after aneurysmal subarachnoid hemorrhage and affects its outcome significantly. Whether fenestration of the lamina terminalis (FLT) during anterior circulation aneurysm clipping for aneurysmal subarachnoid hemorrhage can decrease the occurrence of SDH is still controversial. METHODS: Ovid and PubMed databases were retrieved by the following key words: "hydrocephalus," "subarachnoid hemorrhage," "aneurysm," "fenestration," and "lamina terminalis." The Cochran-Mantel-Haenszel test was used to compare overall incidence of SDH. RESULTS: The literatures were searched, and 15 were included involving 2839 patients. The overall incidence of SDH in fenestrated cohort was 11.4%, compared with 15.3% in the nonfenestrated cohort (P = 0.008). The relative risk of SDH in fenestrated cohort was 0.67 (95% confidence interval 0.50-0.90). CONCLUSIONS: This meta-analysis suggests that FLT during anterior circulation aneurysm clipping reduces the incidence of SDH. However, a well-designed, randomized controlled trial is necessary to prove the efficacy of FLT to reduce SDH.