Fang Yuanjian, Shao Anwen, Wang Xiaoyu, Lu Jianan, Wu Haijian, Ren Reng, Huang Yi, Lenahan Cameron, Xu Jing, Chen Sheng, Zhang Jianmin
Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Eur Radiol. 2021 Mar;31(3):1290-1299. doi: 10.1007/s00330-020-07242-5. Epub 2020 Sep 11.
The basal vein of Rosenthal (BVR) variant is a potential origin of bleeding in angiogram-negative subarachnoid hemorrhage (AN-SAH). We compared the rate and degree of BVR variants in patients with perimesencephalic AN-SAH (PAN-SAH) and non-perimesencephalic AN-SAH (NPAN-SAH).
We retrospectively reviewed the records of AN-SAH patients admitted to our hospital between 2013 and 2018. The associations between variables (baseline characteristics, clinical and radiological data, and outcome) with bleeding patterns and degree of BVR variants were analyzed. Additionally, potential predictors of positive findings on repeated digital-subtracted angiogram (DSA), rebleeding, delayed cerebral infarction (DCI), and poor outcome were further studied.
A total of 273 patients with AN-SAH were included. The incidence rate and degree of BVR variants were significantly higher in PAN-SAH patients compared with those in NPAN-SAH patients (p < 0.001). Patients with normal bilateral BVRs are more likely to have a severe prognosis and diffused blood distribution (p < 0.05). We found an increased rate of positive findings on repeated DSA, DCI, rebleeding, and poor outcome at 3 months and 1 year after discharge (all p < 0.05) in patients with bilateral normal BVRs. Bilateral normal BVRs were considered a risk factor (predictor) of positive findings on repeated DSA, rebleeding, and poor outcome (all p < 0.05).
PAN-SAH patients have a higher rate and degree of BVR variants compared with patients with NPAN-SAH. Those AN-SAH patients with bilateral normal BVRs are more likely to be of arterial origin and are at risk of suffering from rebleeding and a poor outcome.
• Patients with PAN-SAH have a higher rate and degree of BVR variants compared with patients with NPAN-SAH, which suggested that AN-SAH patients with normal BVRs are more likely to originate from arterial bleeding. • AN-SAH patients with normal BVRs are more likely to have positive findings on repeated DSA examinations, as well as an increased incidence of rebleeding and poor outcome, which may assist and guide neurologists in selecting treatment.
罗森塔尔基底静脉（BVR）变异是血管造影阴性的蛛网膜下腔出血（AN-SAH）出血的一个潜在来源。我们比较了中脑周围型AN-SAH（PAN-SAH）患者和非中脑周围型AN-SAH（NPAN-SAH）患者中BVR变异的发生率和程度。
我们回顾性分析了2013年至2018年期间我院收治的AN-SAH患者的病历。分析了变量（基线特征、临床和影像学数据以及结局）与出血模式和BVR变异程度之间的关联。此外，还进一步研究了重复数字减影血管造影（DSA）阳性结果、再出血、迟发性脑梗死（DCI）和不良结局的潜在预测因素。
共纳入273例AN-SAH患者。与NPAN-SAH患者相比，PAN-SAH患者中BVR变异的发生率和程度显著更高（p < 0.001）。双侧BVR正常的患者更有可能预后严重且血液分布弥散（p < 0.）。我们发现，双侧BVR正常的患者在出院后3个月和1年时重复DSA检查阳性结果、DCI、再出血和不良结局的发生率增加（所有p < 0.05）。双侧BVR正常被认为是重复DSA检查阳性结果、再出血和不良结局的危险因素（预测因素）（所有p < 0.05）。
与NPAN-SAH患者相比，PAN-SAH患者中BVR变异的发生率和程度更高。那些双侧BVR正常的AN-SAH患者更可能为动脉源性，且有再出血和不良结局的风险。
• 与NPAN-SAH患者相比，PAN-SAH患者中BVR变异的发生率和程度更高，这表明BVR正常的AN-SAH患者更可能源于动脉出血。• BVR正常的AN-SAH患者在重复DSA检查中更可能有阳性结果，再出血和不良结局的发生率也更高，这可能有助于并指导神经科医生选择治疗方案。
