J Cerebrovasc Endovasc Neurosurg.  2022 Sep;24(3):232-240. 10.7461/jcen.2022.E2022.01.004.

The relationship between non-aneurysmal spontaneous subarachnoid hemorrhage and basilar tip anatomy

Affiliations
  • 1Department of Neurosurgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
  • 2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
  • 3Intensive Care Units, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea

Abstract


Objective
Non-aneurysmal spontaneous subarachnoid hemorrhage (NASAH) has a good prognosis, but its cause has not been clearly identified. In this study, we assessed the clinical and radiological features of NASAH and suggested an anatomical relationship between the basilar tip anatomy and NASAH.
Methods
From August 2013 to May 2020, 21 patients were diagnosed with NASAH at our institution. We evaluated the clinical features of NASAH. NASAH was classified into a perimesencephalic pattern and aneurysmal pattern according to the distribution of hemorrhage based on initial brain computed tomography. Digital subtraction angiography was used to classify the basilar tip anatomy into symmetric cranial fusion, symmetric caudal fusion, or asymmetric fusion types.
Results
Of the 21 patients, twenty patients had a good clinical outcome (modified Rankin Scale (mRS) 1–2; Glasgow Outcome Scale (GOS) 4–5). These patients showed improvement in mRS and Glasgow Coma Scale (GCS) at the last follow-up (P=.003 and P=.016, respectively). Eighteen patients with NASAH (85.7%) had the caudal fusion type, and only three patients with NASAH (14.3%) had the cranial fusion type. Seven patients with the perimesencephalic pattern (77.8%) had the caudal fusion type, and eleven patients with the aneurysmal pattern (91.7%) had the caudal fusion type.
Conclusions
In NASAH patients, the caudal fusion tends to occur frequently among patients with basilar tip anatomy. In the case of the caudal fusion, the perforators around the basilar tip would be more susceptible to hemodynamic stress, which could contribute to the occurrence of NASAH.

Keyword

Non-aneurysmal; Spontaneous; Subarachnoid hemorrhage; Basilar tip; Anatomy

Figure

  • Fig. 1. Perimesencephalic patterns, aneurysmal patterns and basilar tip anatomy on a 3-dimensional reconstruction image of digital subtraction angiography. (A) Brain CT shows perimesencephalic pattern. Hemorrhage exists around the basal cistern with little extension to other cisterns. (B) Brain CT shows aneurysmal pattern. Hemorrhage is distributed beyond the basal cistern. (C) Bilateral superior cerebellar arteries (SCAs) originate from the basilar artery (BA) (white arrows), which shows a cranial fusion type. (D) Bilateral SCAs originate from the posterior cerebral artery (PCA) (white arrows), which shows a symmetric caudal fusion type. (E) The right SCA originates from the PCA (white arrowhead), and the left SCA originates from the BA (white arrow). This shows the asymmetric fusion type. CT, computed tomography

  • Fig. 2. (A) Paired initial modified Rankin Scale (mRS) and the last follow-up mRS. Most of the patients with good clinical outcomes improved the last follow-up mRS compared to the initial mRS. A patient who showed poor clinical outcome had initial mRS 4 and the last follow-up mRS 4. (B) Paired initial Glasgow Coma Scale (GCS) and the last follow-up GCS. In all patients, the last follow-up GCS was equal to or better than the initial GCS.


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