Aneurysmal subarachnoid haemorrhage: Volumetric quantification of the blood distribution pattern to accurately predict the ruptured aneurysm location.

Autor: Mosteiro A; Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain., Culebras D; Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain., Vargas Solano A; Department of Radiology, Hospital Clínic of Barcelona, University of Barcelona, Spain., Moreno Negrete JL; Department of Radiology, Hospital Clínic of Barcelona, University of Barcelona, Spain., López-Rueda A; Department of Radiology, Hospital Clínic of Barcelona, University of Barcelona, Spain., Llull L; Comprehensive Stroke Center, Department of Neurology, Hospital Clínic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Santana D; Comprehensive Stroke Center, Department of Neurology, Hospital Clínic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Pedrosa L; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Amaro S; Comprehensive Stroke Center, Department of Neurology, Hospital Clínic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Torné R; Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. Electronic address: torne@clinic.cat., Enseñat J; Department of Neurosurgery, Hospital Clínic of Barcelona, University of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Jazyk: angličtina
Zdroj: Neurocirugia (English Edition) [Neurocirugia (Astur : Engl Ed)] 2024 May-Jun; Vol. 35 (3), pp. 136-144. Date of Electronic Publication: 2023 Dec 28.
DOI: 10.1016/j.neucie.2023.12.002
Abstrakt: Background: In spontaneous subarachnoid haemorrhage (SAH) accurate determination of the bleeding source is paramount to guide treatment. Traditionally, the bleeding pattern has been used to predict the aneurysm location. Here, we have tested a software-based tool, which quantifies the volume of intracranial blood and stratifies it according to the regional distribution, to predict the location of the ruptured aneurysm.
Methods: A consecutive series of SAH patients admitted to a single tertiary centre between 2012-2018, within 72 h of onset, harbouring a single intracranial aneurysm. A semi-automatized method of blood quantification, based on the relative density increase, was applied to initial non-contrast CTs. Five regions were used to define the bleeding patterns and to correlate them with aneurysm location: perimesencephalic, interhemispheric, right/left hemisphere and intraventricular.
Results: 68 patients were included for analysis. There was a strong association between the distribution of blood and the aneurysm location (p < 0.001). In particular: ACom and interhemispheric fissure (p < 0.001), MCA and ipsilateral hemisphere (p < 0.001), ICA and ipsilateral hemisphere and perimesencephalic cisterns (p < 0.001), PCom and hemispheric, perimesencephalic and intraventricular (p = 0.019), and PICA and perimesencephalic and intraventricular (p < 0.001). The internal diagnostic value was high (AUROC ≥ 0.900) for these locations.
Conclusion: Regional automatised volumetry seems a reliable and objective tool to quantify and describe the distribution of blood within the subarachnoid spaces. This tool accurately predicts the location of the ruptured aneurysm; its use may be prospectively considered in the emergency setting when speed and simplicity are attained.
(Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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