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Deep venous drainage variant rate and degree may be higher in patients with perimesencephalic than in non-perimesencephalic angiogram-negative subarachnoid hemorrhage

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A Correction to this article was published on 23 December 2020

This article has been updated

Abstract

Objectives

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).

Methods

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.

Results

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).

Conclusions

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.

Key Points

• 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.

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Abbreviations

AN-SAH:

Angiogram-negative subarachnoid hemorrhage

BVR:

Basal vein of Rosenthal

CT:

Computed tomography

HH:

Hunt and Hess

IVH:

Intraventricular hemorrhage

mFS:

Modified Fisher scale

NPAN-SAH:

Non-perimesencephalic angiogram-negative subarachnoid hemorrhage

PAN-SAH:

Perimesencephalic angiogram-negative subarachnoid hemorrhage

SAH:

Subarachnoid hemorrhage

SEBES:

Subarachnoid Hemorrhage Early Brain Edema Score

WFNS:

World Federation of Neurosurgeons Scale

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Acknowledgments

We gratefully acknowledge Dr. Hui Shi from Yongchuan Hospital (Chongqing, China) for assisting with the conception of this manuscript. Prof. Jianmin Zhang is the “guarantor” for the entire study.

Funding

This research was supported by the National Natural Science Foundation of China (81870916 and 81971107) and Youth Fund of the National Natural Science Fund project (81701214).

Author information

Author notes

  1. Yuanjian Fang and Anwen Shao contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China

    Yuanjian Fang, Anwen Shao, Xiaoyu Wang, Jianan Lu, Haijian Wu, Reng Ren, Yi Huang, Jing Xu, Sheng Chen & Jianmin Zhang

  2. Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, USA

    Cameron Lenahan

  3. Burrell College of Osteopathic Medicine, Las Cruces, NM, USA

    Cameron Lenahan

  4. Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China

    Jianmin Zhang

  5. Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China

    Jianmin Zhang

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  1. Yuanjian Fang
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Correspondence to Sheng Chen or Jianmin Zhang.

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Guarantor

The scientific guarantor of this publication is Prof. Jianmin Zhang.

Conflict of interest

The authors declare no conflict of interest concerning the findings specified in this paper.

Statistics

Yuanjian Fang and Yi Huang have significant statistical expertise.

Ethics approval statements

This study was approved by Institutional Review Board of The Second Affiliated Hospital of Zhejiang University School of Medicine. No patient consent was required in our study as our Institutional Review Board has approved full waiver of consent.

Methodology

• Retrospective

• Cross-sectional study

• Single center

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The original online version of this article was revised: In the last paragraph of section “Variables”, the third sentence should read: “Scores ranging from 4 to 5 for WFNS and 3–5 HH and 3–4 for mRS and SEBES were considered high for each respective scoring method.” In addition, the definition for WSFN was given incorrectly in tables 1, 3 and 4 and the values of High WFNS were partly incorrect in Table 3.

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Fang, Y., Shao, A., Wang, X. et al. Deep venous drainage variant rate and degree may be higher in patients with perimesencephalic than in non-perimesencephalic angiogram-negative subarachnoid hemorrhage. Eur Radiol 31, 1290–1299 (2021). https://doi.org/10.1007/s00330-020-07242-5

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