Argiti Katerina, Fung Christian, Shah Mukesch Johannes, Vasilikos Ioannis, Schnell Oliver, Beck Jürgen, Rahal Amir El
Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany.
Neurochirurgie. 2023 Oct 27;69(6):101495. doi: 10.1016/j.neuchi.2023.101495.
The incidence of subarachnoid hemorrhage (SAH) is around 9/100 000 people annually, with 15-37% having no identifiable vascular source on angiography. This study aimed to define criteria to identify patients with a possible spinal origin of SAH. We present a literature review and a case of a 61-year-old patient with SAH due to lumbar spinal schwannoma.
A literature search and review were conducted according to the PRISMA-P 2020 guidelines. We performed a restricted search using the keywords "SAH" and "Spinal Schwannoma"; "SAH" and "Ependymoma".
Out of 297 articles, 32 were included between 1951 and 2023 for a total of 44 cases with SAH of spinal origin. Fourteen schwannomas (31.8%) and 30 ependymomas (68.2%) were included in the review. Men represented 77% of the schwannoma and 64% of the ependymoma cohort. The median age was 45 years in the schwannoma vs 29 years in the ependymoma group. Ependymomas were predominantly located in the lumbar spine (85%). Localised spinal symptoms were present in 65% of schwannoma cases, encompassing radicular pain (28%), motor deficit (22%), and incontinence (14.5%). This was 93% in ependymomas, with symptoms being radicular pain (40%), motor deficit (20%), and incontinence (17%). Lumbar punctures diagnosed 86.5% of SAHs, while only 18.2% had subarachnoid bleeding found on a cerebral CT or MRI.
In SAH patients lacking a vascular bleeding source, any spinal symptom must prompt a complete examination of the spinal axis (i.e. MRI). Without spinal symptoms, SAH associated with spinal tumors will likely be missed.
蛛网膜下腔出血（SAH）的年发病率约为9/10万，血管造影显示15%-37%的患者无明确的血管源性病因。本研究旨在确定识别可能源于脊髓的SAH患者的标准。我们进行了文献综述并报告了1例因腰椎神经鞘瘤导致SAH的61岁患者的病例。
根据PRISMA-P 2020指南进行文献检索和综述。我们使用关键词“SAH”和“脊髓神经鞘瘤”；“SAH”和“室管膜瘤”进行了限定检索。
在297篇文章中，1951年至2023年间纳入了32篇，共44例源于脊髓的SAH病例。综述纳入了14例神经鞘瘤（31.8%）和30例室管膜瘤（68.2%）。男性在神经鞘瘤队列中占77%，在室管膜瘤队列中占64%。神经鞘瘤组的中位年龄为45岁，而室管膜瘤组为29岁。室管膜瘤主要位于腰椎（85%）。65%的神经鞘瘤病例出现局部脊髓症状，包括神经根性疼痛（28%）、运动功能障碍（22%）和尿失禁（14.5%）。室管膜瘤患者的这一比例为93%，症状包括神经根性疼痛（40%）、运动功能障碍（20%）和尿失禁（17%）。腰椎穿刺诊断出86.5%的SAH病例，而脑CT或MRI仅发现18.2%的患者存在蛛网膜下腔出血。
对于缺乏血管出血源的SAH患者，任何脊髓症状都必须促使对脊髓轴进行全面检查（即MRI）。若无脊髓症状，与脊髓肿瘤相关的SAH很可能被漏诊。
