Surgical treatment for subarachnoid hemorrhage of unknown etiology : consideration of radiological findings of digital subtraction angiography

• Published in: Neurosurgical review 1998-01, Vol.21 (2-3), p.81-86
• Main Authors: KOYAMA, T, GIBO, H, HIRABAYASHI, F
• Format: Article
• Language: English
• Subjects: Aged; Angiography, Digital Subtraction; Biological and medical sciences; Female; Humans; Intracranial Aneurysm - complications; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - surgery; Tomography, X-Ray Computed
• ISSN: 0344-5607; 1437-2320
• DOI: 10.1007/bf02389309

At present, conventional intra-arterial angiography remains the gold-standard for the diagnosis of etiology of subarachnoid hemorrhage (SAH), but this may change as intra-arterial digital subtraction angiography (IA-DSA) or three-dimensional computerized tomography (CT) angiography improve. The purpose of this study is to investigate the reliability of IA-DSA for the diagnosis of SAH of unknown etiology. Of 184 patients admitted to our unit with proven spontaneous SAH between January, 1994, and March, 1997, 124 underwent IA-DSA. Ten were diagnosed as having SAH of unknown etiology by initial angiography; therefore, the incidence of SAH of unknown etiology based on the diagnosis of initial IA-DSA was 8.1%. Of these 10 patients, six patients were treated conservatively in the acute period. Other four patients underwent exploratory surgeries in the acute period due to a great suspicion of the presence of aneurysms. In one patient, no aneurysm was detected; in three patients aneurysms were discovered at surgery and successfully clipped. In two of three patients, aneurysms were not discovered at the suspected site, because radiological findings of a thrombosed aneurysm and infundibular dilatation of a perforator caused incorrect diagnosis of the aneurysm sites. Although the site of aneurysm diagnosed by IA-DSA is not always correct, exploratory aneurysm surgery during the acute period based on the diagnosis by IA-DSA is warranted, and IA-DSA is acceptable for the diagnosis of SAH of unknown etiology.