Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Postal code - 226014, India.
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Postal code - 226014, India.
Acta Neurochir (Wien). 2022 Jul;164(7):1827-1835. doi: 10.1007/s00701-022-05222-w. Epub 2022 May 7.
The exact cause of bleeding in non-aneurysmal sub-arachnoid hemorrhage (SAH) is yet to be established. The present study intends to evaluate the morphological variants of deep cerebral venous drainage, especially basal veins of Rosenthal (BVR), and to correlate if such a venous anomaly is associated with increased incidence of non-aneurysmal SAH.
A prospective analysis of all the patients of age more than 12 years with spontaneous non-aneurysmal SAH and undergone 4-vessel DSA for the diagnosis of the source of bleeding was included in the study (n = 59). The anatomy of the basal venous distribution was evaluated and was divided into 3 different types, namely normal (Type A), normal variant (Type B), and primitive (Type C), based on DSA findings. The follow-up of these cases was noted. The three groups were compared with one another.
The median age of presentation was 51 years with slight male predominance (52%). Primitive venous drainage was associated with a poorer grade at presentation (p = 0.002), more severe bleed (p = 0.001), vasospasm (p = 0.045), and a poorer outcome at 6 months (p = 0.019). Hydrocephalous and vasospasm were seen in patients with primitive venous drainage. On multivariate regression analysis for poorer outcome, it was observed that a worse grade at presentation, extensive bleed, primitive venous drainage are independent predictors of an adverse outcome.
The presence of primitive venous drainage has a linear relationship with the development of non-aneurysmal SAH with multi-cisternal hemorrhage, worse grade at presentation, and unfavorable outcome.
非动脉瘤性蛛网膜下腔出血（SAH）的确切原因尚未确定。本研究旨在评估深部脑静脉引流的形态变异，特别是罗森塔尔基底静脉（BVR），并探讨这种静脉异常是否与非动脉瘤性 SAH 发生率增加有关。
对所有年龄大于 12 岁且自发性非动脉瘤性 SAH 的患者进行前瞻性分析，对所有患者均进行 4 血管 DSA 以明确出血原因（n=59）。根据 DSA 结果，评估基底静脉分布的解剖结构，并将其分为 3 种不同类型，即正常型（A型）、正常变异型（B 型）和原始型（C 型）。对这些病例进行随访。比较三组之间的差异。
患者的中位年龄为 51 岁，男性略占优势（52%）。原始静脉引流与较差的入院时分级（p=0.002）、更严重的出血（p=0.001）、血管痉挛（p=0.045）和 6 个月时的不良预后（p=0.019）相关。原始静脉引流患者出现脑积水和血管痉挛。在 6 个月时预后不良的多变量回归分析中，发现入院时分级较差、广泛出血和原始静脉引流是不良预后的独立预测因素。
原始静脉引流与非动脉瘤性 SAH 伴多脑池出血、入院时分级较差和不良预后呈线性关系。
