动脉瘤性蛛网膜下腔出血形态分析

Clinical Study of the Pattern of Aneurysmal Subarachnoid Hemorrhage

目的探讨动脉瘤性蛛网膜下腔出血计算机断层扫描(computed tomography,CT)形态特征,根据CT出血形态预判颅内动脉瘤的部位。方法回顾性分析82例动脉瘤性蛛网膜下腔出血患者CT出血形态及全脑血管造影结果,总结不同部位动脉瘤破裂出血CT形态特征。结果大脑前动脉、前交通动脉、大脑中动脉动脉瘤出血CT形态特异,为单纯前纵裂、外侧裂出血,蛛网膜下腔出血伴前纵裂、额叶、外侧裂血肿;颈内动脉、后交通动脉瘤出血CT形态多样,特异性较差,但常见形态为一侧鞍上池、外侧裂出血,波及其他脑池,前纵裂出血少或无出血;大脑后动脉、椎动脉、基底动脉、小脑后下动脉等后循环动脉瘤出血CT形态较典型,为脚间池、桥前池、环池、四叠体池、小脑延髓外侧池、小脑幕上下出血,但与脑干周围非动脉瘤性蛛网膜下腔出血鉴别困难。结论根据特异性CT出血形态能够预判部分大脑前动脉、前交通动脉、大脑中动脉动脉瘤,预判颅内后循环动脉瘤时与脑干周围非动脉瘤性蛛网膜下腔出血鉴别困难,预判颈内动脉、后交通动脉瘤特异性差。

Objective To evaluate the morphological features of aneurysmal subarachnoid hemorrhage on computed tomography （CT） scan, then to forcast the location of intracranial ruptured aneurysms on the basis of the CT results. Methods The manifestation of CT and digital subtraction angiography （DSA） in eighty-two patients with aneurysmal subarachnoid hemorrhage were analyzed. The relationship between the subarachnoid hemorrhage morphology and the location of the intracranial aneurysm was found. Results The distribution of the hemorrhage caused by ruptured aneurysms located on the anterior cerebral artery （ACA）, anterior communicating artery （ACoA） and middle cerebral artery （MCA） are special. The hemorrhage mainly distributes on the anterior longitudinal cistern, sylvian cistern. Sometimes there are hematomas on those cisterns. That caused by ruptured aneurysms located on the internal cerebral artery （ICA） and posterior communicating cerebral artery （PCoA） are various. But the typical hemorrhage distribute on the super-sellar cistern and sylvian cistern. The hemorrhage pattern of ruptured aneurysms on the posterior cerebral circulate such as the posterior cerebral artery （PCA）, basic artery （BA）, vertebral artery （VA） and anterior inferior cerebellum artery （AICA） has its own characteristics, but it＇s difficult to be distinguished with the non- aneurysmal hemorrhage around the brain-stem. The hemorrhage distribute on the interpeduncular cistern, ambient cistern, quadrigeminal cistern, superior and under cerebellar tentorium, prepontine cistern and lateral cerebellomedullary cistern. Conclusion We can predict some ruptured aneurysms located on ACoA, ACA and MCA according to the quantity and distribution of subarachnoid hemorrhage on CT scan. It＇s difficult to distinguished the non-aneurysmal hemorrhage around the brain-stem with the aneurysmal hemorrhage caused by ruptured PCA, VA, BA and AICA aneurysms. It isn＇t accurate to predict the ruptured ICA and PCoA aneurysms because of the various hemorrhage morphology.