中脑周围蛛网膜下腔出血的静脉引流方式

Venous drainage patterns of perimesencephalic subarachnoid hemorrhage

目的探讨脑内不同深静脉引流方式与中脑周围蛛网膜下腔出血(PMSAH)的关系方法回顾性分析2014年1月至2017年1月安徽医科大学第二附属医院诊治的90例蛛网膜下腔出血(SAH)患者的临床资料。其中PMSAH 30例为PMSAH组,动脉瘤性SAH 60例为对照组。单侧大脑半球静脉引流分为A型(正常的连续):基底静脉有大脑深中静脉引流,引流入Galen大脑大静脉;B型(正常的不连续):基底静脉与前方的钩静脉、后方的Galen静脉有不连续静脉引流;C型(原始的变异):未向Galen大脑大静脉引流,中脑周围静脉向岩上窦引流,或基底静脉直接引流入横窦、直窦。双侧大脑半球静脉引流的不同组合分为:正常型引流(Ⅰ型:AA),不连续型引流(Ⅱ型:AB、BB),原始型引流(Ⅲ型:AC、BC、CC),比较两组静脉引流方式的差异。结果 PMSAH组中,Ⅰ、Ⅱ型引流均占26.7%(各8例),Ⅲ型引流占46.7%(14例)。对照组中Ⅰ型引流占48.3%(29例),Ⅱ型引流占28.3%(17例),Ⅲ型引流占23.3%(14例)。3种静脉引流方式在两组中分布比较,差异无统计学意义(χ~2=5.804,P=0.055),但Ⅲ型静脉引流(46.7%比23.3%)在两组间差异有统计学意义(χ~2=5.081,P=0.024)。结论 PMSAH患者的深静脉引流多表现为基底静脉引流入硬脑膜静脉窦,而并非向大脑大静脉引流。提示原始引流入硬膜窦的方式较引流入大脑大静脉的方式更容易破裂。

Objective To investigate the relationship between the different deep venous drainage patterns in the brain and the perimesencephalic subarachnoid hemorrhage（ PMSAH）. Methods From January 2014 to January 2017,the clinical data of 90 patients with subarachnoid hemorrhage（ SAH） diagnosed and treated in the Second Affiliated Hospital of Anhui Medical University were analyzed retrospectively. Thirty patients with PMSAH were in a PMSAH group and 60 patients with aneurismal SAH were in a control group. Unilateral cerebral hemisphere venous drainage was divided into type A（ normal continuous） ： the basilar vein had deep middle cerebral vein drainage and was drained into the great cerebral vein of Galen;type B（ normal discontinuous） ： there was discontinuous venous drainage between the basal vein and the anterior uncal vein and the posterior Galen vein; type C（ primitive variant） ： did not drained into great cerebral vein of Galen,perimesencephalic vein was drained into the superior petrosal sinus or basal vein was directly drained into the transverse sinus or straight sinus. The different combinations of bilateral cerebral hemisphere venous drainage were divided into normal type drainage（ type Ⅰ ： AA）,discontinuous type drainage（ typesⅡ： AB or BB）,and primitive type drainage（ types Ⅲ： AC,BC,or CC）. The differences of venous drainage between the two groups were compared. Results In the PMSAH group,both typesⅠandⅡdrainages accounted for 26. 7 %（ n = 8 in each type） and type Ⅲ accounted for 46. 7 %（ n = 14）. In the control group,typeⅠ accounted for 48. 3 %（ n = 29）,type Ⅱ accounted for 28. 3 %（ n = 17）,and type Ⅲaccounted for 23. 3%（ n = 14）. There were no significant differences in the distribution of three venous drainage patterns between the two groups（ χ^2= 5. 8 0 4,P = 0. 0 5 5）. However,there was significant difference in the types Ⅲ venous drainage between the two groups（ χ^2= 5. 0 8 1,P = 0. 0 2 4）.Conclusion Most of the deep cerebral venous drainage in patients with PMSAH showed basilar venous drainage into the venous sinuses of dura mater,but not to the large cerebral vein drainage,suggesting the way of primitive drainage into the dural sinus was more prone to rupture compared with that of drainage into large cerebral veins.