Often we need to carry out emergent surgery to clip aneurysms in cases of aneurysmal SAH. Opening up the lamina terminalis has the benefit of preventing post-op hydrocephalus. Many surgeons opt to do it routinely, while others are very selective.
I do it regularly but not every time as a way to release more CSF and relax the brain but I am not completely persuaded that it reduces the need for permanent CSF diversion which alway sems about 5% in my practice
Yes I do agree with daniel. However since the procedure is simple and harmless, it should be done at the conclusion of clipping procedure.
There is no evidence that opening the lamina terminalis in patients with aneurysmal SAH results in fewer patients with permanent CSF-diversion. The same holds for the occurrence of vasospasm. Nevertheless, as Daniel states, opening the lamina terminalis results in a more relaxed brain that facilitates surgery, the same as opening the various basal cisterns. Therefore, most of the times I do open the lamina terminalis.
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