Daenekindt Thomas, Wilms Guido, Thijs Vincent, Demaerel Philippe, Van Calenbergh Frank
Department of Neurosurgery, University Hospital Gasthuisberg, Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Surg Neurol. 2008 May;69(5):526-9; discussion 529. doi: 10.1016/j.surneu.2007.03.039. Epub 2008 Feb 8.
The cause of perimesencephalic nonaneurysmal SAH or PMH is not known. Earlier studies reported a possible contribution of a primitive variant of the BVR in the pathogenesis of PMH. We compared the variants of BVR in a case control study between patients with PMH and aneurysmal SAH by studying the venous phase of the DSA.
Two observers reviewed the DSAs of 59 patients with PMH and 59 patients with aneurysmal SAH. The variants of BVR were classified into (1) normal continuous: BVR is continuous with the deep middle cerebral vein and drains mainly into the VG; (2) normal discontinuous: drainage anterior to uncal veins and posterior to the VG; and (3) primitive variant: drainage into veins other than the VG.
One hundred eighteen patients were enrolled, with a mean age of 49 +/- 12 years. There were 31 men and 28 women in each group. Patients with PMH were older than patients with aneurysmal SAH (52 vs 46, P = .01). Primitive variants were found in 21% on the left side and 29% on the right side (P = .27). There was no association between PMH and the presence of a primitive variant on the left (25% in PMH vs 19% in aneurysmal SAH, P = .65) or on the right side (31% in PMH vs 30% in aneurysmal SAH, P = .92) in univariate analysis. After correction for age and sex, variants on neither side were associated with PMH (OR: 1.4, P = .53 for left variants and 1.2, P = .67 for right variants).
In this large controlled study, we were unable to confirm a contribution of a primitive variant of the BVR in the pathogenesis of PMH.
中脑周围非动脉瘤性蛛网膜下腔出血（PMH）的病因尚不清楚。早期研究报道BVR的原始变异可能在PMH的发病机制中起作用。我们通过研究数字减影血管造影（DSA）的静脉期，在一项病例对照研究中比较了PMH患者和动脉瘤性蛛网膜下腔出血患者的BVR变异情况。
两名观察者对59例PMH患者和59例动脉瘤性蛛网膜下腔出血患者的DSA进行了回顾。BVR变异分为：（1）正常连续型：BVR与大脑中深静脉连续，主要引流至大脑大静脉（VG）；（2）正常间断型：引流至钩静脉前方和VG后方的静脉；（3）原始变异型：引流至VG以外的静脉。
共纳入118例患者，平均年龄49±12岁。每组有31名男性和28名女性。PMH患者比动脉瘤性蛛网膜下腔出血患者年龄更大（52岁对46岁，P = 0.01）。左侧发现原始变异型的比例为21%，右侧为29%（P = 0.27）。单因素分析显示，左侧或右侧存在原始变异型与PMH均无关联（PMH中为25%，动脉瘤性蛛网膜下腔出血中为19%，P = 0.65；PMH中为31%，动脉瘤性蛛网膜下腔出血中为30%，P = 0.92）。校正年龄和性别后，两侧的变异型均与PMH无关（左侧变异型的比值比：1.4，P = 0.53；右侧变异型的比值比：1.2，P = 0.67）。
在这项大型对照研究中，我们无法证实BVR的原始变异在PMH发病机制中的作用。
