J Neurol Surg A Cent Eur Neurosurg 2022; 83(04): 344-350
DOI: 10.1055/s-0041-1733895
Original Article

A New Insight in Nonaneurysmal Subarachnoid Hemorrhage: The Potential Role of the Internal Jugular Veins

Alba Scerrati
1   Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
,
Pasquale De Bonis
2   Department of Neurosurgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
,
Paolo Zamboni
3   Department of Vascular Surgery, University of Ferrara, Ferrara, Emilia-Romagna, Italy
,
Flavia Dones
1   Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
,
4   Neurosurgery Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Brescia, Italy
,
Marco Cenzato
5   Department of Neurosurgery, Ospedale Niguarda Ca Granda, Milano, Lombardia, Italy
,
Jacopo Visani
1   Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
,
Federico Bianchi
6   Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
,
Luca Zanin
7   Department of Neurosurgery, University of Brescia, Brescia, Lombardia, Italy
,
Michele Alessandro Cavallo
1   Dipartimento di Morfologia, Azienda Ospedaliera Sant'Anna, UOC di Neurochirurgia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
,
6   Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
› Author Affiliations

Abstract

Background Causes of the nonaneurysmal subarachnoid hemorrhage (na-SAH) are still debated. Many studies confirmed the possible involvement of the intracranial venous system, in particular variants of the basal vein of Rosenthal.

Study Object The aim of this study is to investigate the role of extracranial venous system, in particular the jugular drainage, in the na-SAH pathophysiology.

Materials and Methods This is a multicenter retrospective study including patients suffering from na-SAH who were radiologically screened to exclude vascular malformations. The course of the internal jugular veins was evaluated to reveal any stenosis (caliber reduction >80%). Particular attention was paid at the passage between the styloid process and the arch of C1 to detect possible compression. As a control group, we enrolled patients who underwent CT angiograms and/or cerebral DSAs in the past 2 years.

Results We included 194 patients. The na-SAH group consisted of 94 patients, whereas the control group consisted of 100 patients. Fifty patients of the control group underwent a CT angiography for an ischemic cerebrovascular disease or trauma and 50 patients for an SAH due to a ruptured aneurysm. A significant jugular stenosis was found in 49 (52.1%) patients in the na-SAH group and in 18 (18%) patients in the control group. At univariate and multivariate analysis, the difference was statistically significant (p < 0.0001).

Conclusions This is the first study investigating the correlation between jugular stenosis and the occurrence of na-SAH. The impaired venous outflow due to reduced venous caliber could result in an engorgement of the upstream intracranial veins with transient hypertensive phases facilitating ruptures. Further larger prospective studies are necessary to confirm these data.



Publication History

Received: 08 July 2020

Accepted: 12 February 2021

Article published online:
22 October 2021

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