自发性蛛网膜下腔出血首次血管造影阴性患者诊治进展

Advances in the management of patients with spontaneous subarachnoid hemorrhage with negative first angiography

自发性蛛网膜下腔出血(spontaneous subarachnoid hemorrhage,sSAH)是神经外科常见的危急重症之一,目前仍有较高的致死致残率。针对该类患者,尽快完善计算机断层扫描血管造影(computed tomographic angiography,CTA)或数字减影脑血管造影(digital subtraction angiography,DSA)检查明确出血原因及部位,并根据确定的原因尽快采取手术治疗,这对改善患者预后显得尤为重要。然而,有部分患者首次血管造影存在假阴性,其原因包括多方面,如中脑周围蛛网膜下腔出血、微小动脉瘤、血栓性动脉瘤、颅内血管畸形、脊髓血管畸形以及阅片者经验等。首次造影阴性的患者必须复查,尤其是针对那些发病后头颅CT平扫高度怀疑动脉瘤患者,复查建议在早期(<2周)及中期(2~8周)进行,同时需提高对微小血管病变的警惕性及识别能力,借助于最新影像学技术,提高对病因的首次检出率。

Spontaneous subarachnoid hemorrhage(sSAH)is one of the common critical illnesses in neurosurgery,and still has a high rate of death and disability.For these patients,computed tomographic angiography(CTA)or digital subtraction angiography(DSA)should be performed as soon as possible to identify the cause and location of the hemorrhage,and surgery should be performed as soon as possible according to the identified cause.This is particularly important to improve the prognosis of patients.However,some patients have false-negative first-time angiograms for a variety of reasons,such as perimesencephalic subarachnoid hemorrhage,microaneurysms,thrombotic aneurysms,intracranial vascular malformations,spinal vascular malformations,and the experience of the radiologists.Patients with a negative first imaging must be followed up,especially in patients with a high suspicion of aneurysm on CT scanning of the head after onset.The time of the reexamination is recommended to be in the early(<2 weeks)and mid-term(2-8 weeks)stages after the disease,and to increase the vigilance and ability to recognize microvascular lesions,and to improve the ability of first-time detection of the cause with the help of the latest imaging techniques.