Rohde V, Mayfrank L, Bertalanffy H, Mull M, Gilsbach J M
Neurochirurgische Klinik, Universitätsklinik Aachen, Germany.
Zentralbl Neurochir. 2003;64(3):116-22. doi: 10.1055/s-2003-41882.
To investigate if the intracisternal distribution of subarachnoid hemorrhage (SAH) following aneurysm rupture allows the correct prediction of the symptomatic aneurysm site. [nl]
Ninety-nine consecutive patients with acute SAH and angiographically proven aneurysm were included into the study. The parent vessel of the diagnosed aneurysms were the anterior communicating artery (ACoA) in 38 patients, the middle cerebral artery (MCA) in 26 patients, the internal carotid artery (ICA) in 25 patients, the pericallosal artery (A2) in 5 patients, the basilar artery (BA) in 4 patients and the vertebral artery (VA) in 1 patient. In 21 patients, an additional asymptomatic aneurysm was diagnosed. The initial computerized tomography (CT) scans of the 99 patients were given to 2 experienced vascular neurosurgeons, who were blinded for the angiography findings. The 2 investigators had to predict the site of the ruptured aneurysm. [nl]
Investigator 1 correctly predicted the aneurysm site in 56 (57 %), investigator 2 in 59 of the 99 patients (60 %). Investigator 1 correctly identified 81 % of the MCA aneurysms, and investigator 2 74 % of the ACoA aneurysms. However, in only 46 of the 99 patients (47 %), the aneurysm site was correctly predicted by both investigators together. [nl]
The results indicate, that the distribution of the subarachnoid blood as shown on the first CT scan after aneurysm rupture barely allows to predict the symptomatic aneurysm site. Thus, neurosurgical decision making (identification of the ruptured aneurysm in patients with multiple aneurysms; surgical exploration in patients with non-perimesencephal SAH, but negative angiography) should not rely on the first CT scan after SAH.
探讨动脉瘤破裂后蛛网膜下腔出血（SAH）在脑池内的分布情况是否能正确预测有症状动脉瘤的位置。[荷兰语]
99例急性SAH且经血管造影证实有动脉瘤的连续患者纳入本研究。诊断出的动脉瘤的供血动脉，38例为前交通动脉（ACoA），26例为大脑中动脉（MCA），25例为颈内动脉（ICA），5例为胼周动脉（A2），4例为基底动脉（BA），1例为椎动脉（VA）。21例患者还诊断出一个额外的无症状动脉瘤。将99例患者的初始计算机断层扫描（CT）图像交给2名经验丰富的血管神经外科医生，他们对血管造影结果不知情。这2名研究人员必须预测破裂动脉瘤的位置。[荷兰语]
研究人员1正确预测出99例患者中56例（57%）的动脉瘤位置，研究人员2正确预测出59例（60%）。研究人员1正确识别出81%的MCA动脉瘤，研究人员2正确识别出74%的ACoA动脉瘤。然而，99例患者中只有46例（47%）被两名研究人员共同正确预测出动脉瘤位置。[荷兰语]
结果表明，动脉瘤破裂后首次CT扫描显示的蛛网膜下腔血液分布几乎无法预测有症状动脉瘤的位置。因此，神经外科决策（在有多发性动脉瘤的患者中识别破裂动脉瘤；在非环池周围SAH但血管造影阴性的患者中进行手术探查）不应依赖于SAH后的首次CT扫描。
