Song Jian-Ping, Ni Wei, Gu Yu-Xiang, Zhu Wei, Chen Liang, Xu Bin, Leng Bin, Tian Yan-Long, Mao Ying
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China.
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040; State Key Laboratory of Medical Neurobiology, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200032, China.
Chin Med J (Engl). 2017 Apr 5;130(7):776-781. doi: 10.4103/0366-6999.202729.
Nontraumatic spontaneous subarachnoid hemorrhage (SAH) is associated with a high mortality. This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.
From January 2006 to December 2008, the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated. Emergent digital subtraction angiography (DSA) was performed for the diagnosis of SAH sources in the acute stage of SAH (≤3 days). The results and complications of emergent DSA were analyzed. Repeated DSA or computed tomography angiography (CTA) was suggested 2 weeks later if initial angiographic result was negative.
A total of 2562 patients were enrolled, including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH. The total complication rate of emergent DSA was 3.9% without any mortality. Among the patients with aneurysmal SAH, 321 cases (15.4%) had multiple aneurysms, and a total of 2435 aneurysms were detected. The aneurysms mostly originated from the anterior communicating artery (30.1%), posterior communicating artery (28.7%), and middle cerebral artery (15.9%). Among the nonaneurysmal SAH cases, 76.5% (n = 365) had negative initial DSA, including 62 cases with peri-mesencephalic nonaneurysmal SAH (PNSAH). Repeated DSA or CTA was performed in 252 patients with negative initial DSA, including 45 PNSAH cases. Among them, the repeated angiographic results remained negative in 45 PNSAH cases, but 28 (13.5%) intracranial aneurysms were detected in the remaining 207 cases. In addition, brain arteriovenous malformation (AVM, 7.5%), Moyamoya disease (7.3%), stenosis or sclerosis of the cerebral artery (2.7%), and dural arteriovenous fistula or carotid cavernous fistula (2.3%) were the major causes of nonaneurysmal SAH.
DSA can be performed safely for pathological diagnosis in the acute stage of SAH. Ruptured intracranial aneurysms, AVM, and Moyamoya disease are the major causes of SAH detected by emergent DSA in China.
非创伤性自发性蛛网膜下腔出血（SAH）的死亡率很高。本研究旨在调查中国非创伤性自发性SAH的流行病学特征。
对2006年1月至2008年12月期间来自中国32个主要神经外科中心的非创伤性SAH患者的临床资料进行评估。在SAH急性期（≤3天）进行急诊数字减影血管造影（DSA）以诊断SAH的病因。分析急诊DSA的结果及并发症。如果初始血管造影结果为阴性，则建议在2周后重复进行DSA或计算机断层血管造影（CTA）。
共纳入2562例患者，其中动脉瘤性SAH占81.4%，非动脉瘤性SAH占18.6%。急诊DSA的总并发症发生率为3.9%，无死亡病例。在动脉瘤性SAH患者中，321例（15.4%）有多个动脉瘤，共检测到2435个动脉瘤。动脉瘤大多起源于前交通动脉（30.1%）、后交通动脉（28.7%）和大脑中动脉（15.9%）。在非动脉瘤性SAH病例中，76.5%（n = 365）的初始DSA结果为阴性，其中包括62例中脑周围非动脉瘤性SAH（PNSAH）。对252例初始DSA结果为阴性的患者进行了重复DSA或CTA检查，其中包括45例PNSAH病例。其中，45例PNSAH病例的重复血管造影结果仍为阴性，但在其余207例病例中检测到28例（13.5%）颅内动脉瘤。此外，脑动静脉畸形（AVM，7.5%）、烟雾病（7.3%）、脑动脉狭窄或硬化（2.7%）以及硬脑膜动静脉瘘或颈动脉海绵窦瘘（2.3%）是非动脉瘤性SAH的主要病因。
在SAH急性期，DSA可安全地用于病理诊断。颅内动脉瘤破裂、AVM和烟雾病是中国急诊DSA检测到的SAH的主要病因。
