Brugada-Bellsolà Ferran, González-Crespo Antonio, Pastor-Cabeza Marta, Blanco Ibáñez de Opacua Alberto, Remollo Sebastian, Anglada-Oliván Mireia, Misis Maite, Domínguez Carlos J, Rimbau Jordi M, Rodríguez-Hernández Ana
Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain.
Department of Neuroscience, Interventional Neuroradiology Unit, Germans Trias i Pujol University Hospital, Badalona, Spain.
World Neurosurg. 2021 Dec;156:e266-e275. doi: 10.1016/j.wneu.2021.09.052. Epub 2021 Sep 20.
Venous hypertension associated with a primitive basal vein of Rosenthal (BVR) has been noted as the most likely cause of idiopathic subarachnoid hemorrhage (iSAH). Other types of venous drainage variations have been scarcely studied but may further explain the cases not associated with a BVR anomaly. Our aim was to investigate if dural venous sinus (DVS) anomalies are related with iSAH.
A total of 76 patients diagnosed with iSAH were identified from a prospectively maintained database and their angiographic findings compared with 76 patients diagnosed with aneurysmal subarachnoid hemorrhage.
On top of the BVR variations, our data showed a higher prevalence of transverse sinus hypoplasia (47.4% vs. 28.9%; P = 0.019), superior petrosal sinus hypoplasia (32.9% vs. 13.2%; P = 0.003), and clival plexus hyperplasia (65.8% vs. 43.4%; P = 0.005) in patients with iSAH. Analyzing by total number of angiograms, the iSAH group showed also a higher prevalence of inferior petrosal sinus hyperplasia (36.2% vs. 25%; P = 0.003). Of the patients with iSAH without a primitive BVR, 84% harbored ≥1 perimesencephalic DVS variation and the overall number of venous drainage variations was significantly higher in patients with iSAH.
In addition to the well-documented BVR anomalies, there seems to be a significant relationship of other DVS variations in patients with iSAH. Transverse sinus hypoplasia, superior petrosal sinus hypoplasia, inferior petrosal sinus hyperplasia, and clival plexus hyperplasia were significantly more frequent in patients with iSAH. The presence of ≥3 of those variations would increase the suspicion of a nonaneurysmatic subarachnoid hemorrhage and could help avoid a second angiogram.
与原始罗森塔尔基底静脉（BVR）相关的静脉高压被认为是特发性蛛网膜下腔出血（iSAH）最可能的原因。其他类型的静脉引流变异很少被研究，但可能进一步解释与BVR异常无关的病例。我们的目的是研究硬脑膜静脉窦（DVS）异常是否与iSAH相关。
从一个前瞻性维护的数据库中识别出76例诊断为iSAH的患者，并将他们的血管造影结果与76例诊断为动脉瘤性蛛网膜下腔出血的患者进行比较。
除了BVR变异外，我们的数据显示，iSAH患者中横窦发育不全（47.4%对28.9%；P = 0.019）、岩上窦发育不全（32.9%对13.2%；P = 0.003）和斜坡丛增生（65.8%对43.4%；P = 0.005）的发生率更高。按血管造影总数分析，iSAH组岩下窦增生的发生率也更高（36.2%对25%；P = 0.003）。在没有原始BVR的iSAH患者中，84%存在≥1种中脑周围DVS变异，iSAH患者静脉引流变异的总数显著更高。
除了有充分记录的BVR异常外，iSAH患者中其他DVS变异似乎也存在显著关系。横窦发育不全、岩上窦发育不全、岩下窦增生和斜坡丛增生在iSAH患者中明显更常见。存在≥3种这些变异会增加对非动脉瘤性蛛网膜下腔出血的怀疑，并有助于避免进行第二次血管造影。
