Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(03): 175-178
DOI: 10.1055/s-0035-1559891
Original Article | Artigo Original
Thieme Publicações Ltda Rio de Janeiro, Brazil

Eficácia da fenestração da lâmina terminal associada à fenestração da membrana de Liliequist na prevenção de hidrocefalia crônica em pacientes operados na fase aguda por aneurisma cerebral roto

Efficacy of Lamina Terminalis Fenestration Associated whith Liliequist' Membrane in reducing Shunt-Dependent Hydrocephalus following Aneurysmal Subarachnoid Hemorrhage
Marcelo Minamoto Miyabe
1   Residente de Neurocirurgia no Hospital Central da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
,
Juan Antonio Castro Flores
2   Assistente da Disciplina de Neurocirurgia do Hospital Central da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
,
Jose Carlos Esteves Veiga
3   Chefe da Disciplina de Neurocirurgia do Hospital Central da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
› Author Affiliations
Further Information

Publication History

22 July 2014

12 June 2015

Publication Date:
24 September 2015 (online)

Resumo

Objetivos Hidrocefalia tardia que requer implante de derivação liquórica é frequente após hemorragia subaracnóidea por aneurisma cerebral roto, e contribui para a morbimortalidade tardia. Alguns autores reportam que a fenestração microcirúrgica da Lâmina Terminal, durante a cirurgia do aneurisma diminui a incidência de hidrocefalia tardia.

Material e Método No período de Janeiro de 2010 a Janeiro de 2012 realizamos a fenestração da Lâmina Terminal associada à fenestração da Membrana de Liliequist, em 17 pacientes operados na fase aguda por aneurisma roto. Monitoramos por tomografia a presença de hidrocefalia após 6 e 16 meses.

Resultados Nenhum paciente apresentou hidrocefalia tardia.

Conclusão A fenestração da Lâmina Terminal associada à fenestração da Membrana de Liliequist é eficaz na prevenção da hidrocefalia tardia pós hemorragia subaracnóidea por aneurisma roto.

Abstract

Objectives Chronic hydrocephalus requiring shunt placement is common following aneurysm subarachnoid hemorrhage, and contributes to the late morbidity and mortality Some authors report that microsurgery fenestration of Lamina Terminalis during aneurysm surgery affords a reduction in the development shunt-dependent hydrocephalus.

Methods From January 2010 to January 2012 we performed microsurgery fenestration of Lamina Terminalis and Liliequist's Membrane, in 17 patients operated in the acute phase. CT scans were performed after 6 and 16 months

Result There was no development of hydrocephalus in this series.

Conclusion Microsurgery fenestration of Lamina Terminalis associated with Liliequist's Membrane fenestration is effective in preventing late hydrocephalus after subarachnoid hemorrhage due to ruptured aneurysm.

 
  • Referências

  • 1 Connolly Jr ES, Rabinstein AA, Carhuapoma JR , et al; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 2012; 43 (6) 1711-1737
  • 2 Komotar RJ, Hahn DK, Kim GH , et al. Efficacy of lamina terminalis fenestration in reducing shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage: a systematic review. Clinical article. J Neurosurg 2009; 111 (1) 147-154
  • 3 Komotar RJ, Hahn DK, Kim GH , et al. The impact of microsurgical fenestration of the lamina terminalis on shunt-dependent hydrocephalus and vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 2008; 62 (1) 123-132 , discussion 132–134
  • 4 Mura J, Rojas-Zalazar D, Ruíz A, Vintimilla LC, Marengo JJ. Improved outcome in high-grade aneurysmal subarachnoid hemorrhage by enhancement of endogenous clearance of cisternal blood clots: a prospective study that demonstrates the role of lamina terminalis fenestration combined with modern microsurgical cisternal blood evacuation. Minim Invasive Neurosurg 2007; 50 (6) 355-362
  • 5 Froelich SC, Abdel Aziz KM, Cohen PD, van Loveren HR, Keller JT. Microsurgical and endoscopic anatomy of Liliequist's membrane: a complex and variable structure of the basal cisterns. Neurosurgery 2008; 63 (1) (Suppl. 01) ONS1-ONS8 , discussion ONS8–ONS9
  • 6 Buxton N, Vloeberghs M, Punt J. Liliequist's membrane in minimally invasive endoscopic neurosurgery. Clin Anat 1998; 11 (3) 187-190
  • 7 Miyajima M, Arai H, Okuda O, Hishii M, Nakanishi H, Sato K. Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases. J Neurosurg 2000; 93 (1) 62-67