Fisher Grade and Lamina Terminalis Fenestration on Hydrocephalus in Patients with Bleeding Subarachnoidal Hemorrhage

INTRODUCTION: Incidence of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is variable between 6% and 67%. LTF is an alternative intra-operative procedure which can be used in patients with aSAH which bleeds into ventricles. It allows the reorganization of the cerebrospinal fluid (CSF) circulation and decreases the CSF pressure and increases cerebral perfusion pressure. The aim of this study was to assess the short-term effects of LTF on hydrocephalus in patients with SAH.
METHODS: 105 patients with a diagnosis of aSAH treated in Ümraniye Research and Training Hospital which underwent surgi-cal clipping were included in our study. Some patients underwent LTF with an intraoperative decision. Our results were evaluated with regard to the presence of hydrocephalus, external ventricular drainage, and/or ventriculoperitoneal shunt need.
RESULTS: 105 patients with aSAH were included in the study. According to first CT imaging of these patients, Fisher scores were given. Thirty-one patients had scored 1, 24 scored 2, 24 scored 4, and 26 scored 4. In 25 of 55 patients with Fisher Scores 1–2, LTF was applied, and shunt-dependent hydrocephalus was observed in two of them in the long term. In 38 of 50 patients with Fisher Scores 3–4, LTF was applied, and shunt-dependent hydrocephalus was observed in 16 of them.
DISCUSSION AND CONCLUSION: Risk of hydrocephalus in LTF-applied patients was lower in Fisher Grade 1–2 patients when compared to Grade 3–4 patients. LTF is an easy and efficacious procedure that allows cerebral relaxation before surgical clipping and decreases the risk of developing hydrocephalus after clipping. Since it decreases the risk of developing hydrocephalus both in lower and higher Fisher Grade groups, although the decrease in risk is more in lower grade group, we recommend that LTF should be applied.