T. Koyama et al., SURGICAL-TREATMENT FOR SUBARACHNOID HEMORRHAGE OF UNKNOWN ETIOLOGY - CONSIDERATION OF RADIOLOGICAL FINDINGS OF DIGITAL SUBTRACTION ANGIOGRAPHY, Neurosurgical review, 21(2-3), 1998, pp. 81-86
At present, conventional intra-arterial angiography remains the gold-s
tandard for the diagnosis of etiology of subarachnoid hemorrhage (SAH)
, but this may change as intra-arterial digital subtraction angiograph
y (IA-DSA) or three-dimensional computerized tomography (CT) angiograp
hy im prove The purpose of this study is to investigate the reliabilit
y of IA-DSA for the diagnosis of SAH of unknown etiology Of 184 patien
ts admitted to our unit with proven spontaneous SAH between January, 1
994, and March, 1997, 124 underwent IA-DSA. Ten were diagnosed as havi
ng SAH of unknown etiology by initial angiography; therefore, the inci
dence of SAH of unknown etiology based on the diagnosis of initial IA-
DSA was 8.1 %. Of these 10 patients,sis patients were treated conserva
tively in the acute period. Other four went exploratory surgeries in t
he 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 dilat
ation of a perforator caused incorrect diagnosis of the aneurysm sites
. Although the site of aneurysm diagnosed by IA-DSA is not always corr
ect. exploratory aneurysm surgery during the acute period based on the
diagnosis by IA-DSA is warranted, and IA-DSA is acceptable for the di
agnosis of SAH of unknown etiology.