Analysis The Effect Of Fenestration The Lamina Terminalis On Prognosis Of Patients With Anterior Communicating Artery Aneurysm Subarachnoid Hemorrhage

Objective:Rupture of the intracranial aneurysm is a serious life-threatening cerebrovascular hemorrhagic disease.The anterior communicating aneurysm accounts for a large proportion of the aneurysms,and its surrounding anatomical relationship is complex and involves many important structures.Although timely and effective treatment is taken after rupture,many complications are often left behind.One of its common complications is chronic hydrocephalus,which usually increases the patient’s hospital stay and costs,causing neurological dysfunction,difficulty walking and urinary incontinence.Shunt surgery can be one of the ways to relieve hydrocephalus.Fenestration the lamina terminalis(FLT)can prevent and treat hydrocephalus after aneurysmal subarachnoid hemorrhage(a SAH),but its effect and mechanism are still the focus of many scholars.The purpose of our study is analysis the effect of FLT on the prognosis of patients with anterior communicating aneurysm.Methods:51 patients with anterior communicating artery aneurysm subarachnoid hemorrhage,which was collect through outpatient,telephone and hospital information management system,who were hospitalized in our hospital from July 2014 to July 2016 were retrospectively analyzed.CTA or DSA showed that the anterior communicating artery aneurysm was the responsible bleeding focus and the clipping of the anterior communicating artery aneurysm wasperformed within 72 hours after admission.According to whether the FLT was performed or not recorded during the operation,it was divided into two groups: group I(FLT)and Group II(non FLT).To observe whether chronic hydrocephalus occurred in patients with CT or MRI,from 2 weeks to 6 months after operation,and to record GOS score,incidence rate of shunt dependent hydrocephalus and chronic hydrocephalus.Results:1.There were 24 male and 27 female patients with anterior communicating aneurysm clamping.The mean age of the patients in the FLT group was 52.50 ±10.61 years old,and that in the non-FLT group was 51.15±98 years old.12 cases(23.5%)had acute hydrocephalus before operation,9 cases(17.6%)had intraventricular hemorrhage before operation,3 cases(5.9%)had aneurysm rupture times more than 2 times.There was no significant difference in sex,age,rupture frequency,Hunt-Hess and Fisher grade between the two groups(p> 0.05).2.A total of 11 patients(21.6%)developed chronic hydrocephalus and 3 patients(5.9%)developed shunt dependent hydrocephalus.The GOS prognostic score of the FLT group was 4.08 ±0.83.The GOS prognostic score of the non-FLT group was 3.30 ±0.82,and the mean hospitalization time was 13.83 ±1.24(days)and 15.39 ±1.90(days)in the FLT group and non-FLT group,respectively.The length of stay,GOS score,incidence of chronic hydrocephalus and shunt dependent hydrocephalus were compared between the two groups.There were significant differences in the incidence of chronic hydrocephalus(p<0.05),the mean hospitalization time(p<0.05),the prognostic score of GOS(p<0.05),and the incidence of chronic hydrocephalus(P<0.05).However,there was no significant difference in the progression of shunt dependent hydrocephalus(p>0.05).Conclusion:Auxiliary fenestration of the lamina terminalis(FLT)andMicro-clipping the ruptured communicating aneurysm,by increasing the cerebrospinal fluid circulation pathway,reducing the occurrence of chronic hydrocephalus,reducing the hospitalization time and promoting the early discharge of the patients.The prognosis of GOS was improved.It is suggested that FLT should be performed for the clipping treatment of anterior communicating aneurysm.