Assessing the Influence of Lamina Terminalis Opening in Aneurysm Surgery: Clinical Outcomes and Ventriculoperitoneal Shunt Insertion Rates.

Background Opening the lamina terminalis during microsurgical clipping of anterior communicating artery (AComA) aneurysms has been proposed to reduce postoperative hydrocephalus and shunt dependency. Methods We retrospectively reviewed 113 patients who underwent microsurgical clipping for aneurysmal subarachnoid hemorrhage (aSAH). Patient demographics, operative notes, and outcomes were collected. The primary endpoint was ventriculoperitoneal shunt (VPS) placement, and the secondary endpoint was postoperative hydrocephalus. Outcomes were compared between patients with and without lamina terminalis opening using descriptive statistics and Fisher's exact test.  Results The lamina terminalis was opened in 84 patients (74.3%). VPS placement was required in four patients overall, all from the fenestration group (4/84, 4.8% vs 0/29, 0%; p = 0.57). Hydrocephalus occurred in 30 patients with fenestration (35.7%) and 10 without (34.5%; p = 1.00). No significant differences were observed between groups for either endpoint. Conclusion In this single-center cohort, no measurable difference was observed. These findings suggest that fenestration may be useful intraoperatively for cerebrospinal fluid release and exposure, but it should not be relied upon as a preventive measure against long-term shunt dependence.