Pechlivanis I, Shang F, Harders A, Schulte-Altedorneburg G, Nölte I, Schmieder K
Ruhr-University of Bochum, Department of Neurosurgery, Bochum, Germany.
Cent Eur Neurosurg. 2011 May;72(2):78-83. doi: 10.1055/s-0030-1268500. Epub 2011 Feb 22.
In 95% of patients with an apparently normal distribution of blood using unenhanced computed tomography (CT), no ruptured aneurysm for a perimesencephalic subarachnoid hemorrhage (PMSAH) will be detected. In general, the clinical course of these patients is more favorable than that of patients with a detected ruptured aneurysm. We wanted to assess whether vessel variants of the vertebro-basilar circulation are more common in patients with PMSAH than in patients with SAH caused by intracranial aneurysms. Furthermore, we wanted to investigate whether CT angiography (CTA) as a sole diagnostic modality in PMSAH is sufficient.
In patients diagnosed with PMSAH (study group), a CTA was performed routinely as the first-line diagnostic modality. If no aneurysm was found, digital subtraction angiography (DSA) was done. CTA and DSA data sets were analyzed for the presence of an intracranial aneurysm. Furthermore, the diameter of the arteries in the posterior circulation was measured. Special attention was paid to vascular variations. Moreover, CTA and DSA findings were compared with data sets from patients with SAH and an intracranial aneurysm of the posterior circulation (control group).
Between January 2002 and June 2007, 28 patients with PMSAH were enrolled in our study. All patients received both CTA and DSA. Furthermore, 28 control data sets were analyzed. Image analysis showed hypoplasia of one or more arterial vessels in 92.9% of PMSAH patients vs. 60.7% of the patients in the control group (p=0.010). Moreover, aplasia of one vessel occurred significantly more often in the study group (53.6%) than in the control group (21.4%; p=0.026). 8 patients in the control group vs. no patients in the study group showed no vessel variants (p=0.004). DSA did not show additional vessel variants, nor did it provide additional information regarding the vessel diameter.
Interestingly, an increased number of arterial vessel hypoplasia was detected in PMSAH patients. Furthermore, CTA as a sole diagnostic modality in patients with typical PMSAH is sufficient.
在95%经未增强计算机断层扫描（CT）显示血液分布看似正常的患者中，不会检测到导致中脑周围蛛网膜下腔出血（PMSAH）的破裂动脉瘤。一般来说，这些患者的临床病程比检测到破裂动脉瘤的患者更有利。我们想评估椎基底循环的血管变异在PMSAH患者中是否比颅内动脉瘤导致的蛛网膜下腔出血（SAH）患者更常见。此外，我们想研究CT血管造影（CTA）作为PMSAH的唯一诊断方式是否足够。
在诊断为PMSAH的患者（研究组）中，常规进行CTA作为一线诊断方式。如果未发现动脉瘤，则进行数字减影血管造影（DSA）。分析CTA和DSA数据集以确定颅内动脉瘤的存在。此外，测量后循环中动脉的直径。特别关注血管变异情况。此外，将CTA和DSA的结果与后循环SAH和颅内动脉瘤患者（对照组）的数据集进行比较。
2002年1月至2007年6月期间，28例PMSAH患者纳入我们的研究。所有患者均接受了CTA和DSA检查。此外，分析了28个对照数据集。图像分析显示，92.9%的PMSAH患者存在一根或多根动脉血管发育不全，而对照组为60.7%（p = 0.010）。此外，研究组中一根血管发育不全的发生率（53.6%）显著高于对照组（21.4%；p = 0.026）。对照组有8例患者未发现血管变异，而研究组无患者出现这种情况（p = 0.（此处原文可能有误，推测为0.004））。DSA未显示额外的血管变异，也未提供有关血管直径的额外信息。
有趣的是，在PMSAH患者中检测到动脉血管发育不全的数量增加。此外，CTA作为典型PMSAH患者的唯一诊断方式是足够的。
