Selective computed tomographic angiography in traumatic subarachnoid hemorrhage: a pilot study.

Area of Science:

• Neurosurgery
• Radiology
• Trauma Surgery

Background:

• Computed tomographic angiography (CTA) is frequently overused in patients with traumatic subarachnoid hemorrhage (tSAH) to exclude intracranial aneurysms.
• A hypothesis suggests two patient subsets with tSAH are at higher risk for aneurysms: those with unknown injury mechanisms ('found down') and those with central subarachnoid hemorrhage (CSH).

Purpose of the Study:

• To evaluate the validity of the hypothesis regarding selective CTA screening in tSAH patients.
• To identify specific patient characteristics that predict the presence of intracranial aneurysms in the setting of tSAH.

Main Methods:

• Retrospective analysis of trauma patients with tSAH who underwent CTA.
• Statistical analysis included Student t-test, chi-squared test, Mann-Whitney U test, and binary logistic regression.
• Principal outcome was the diagnosis of intracranial aneurysm.

Main Results:

• Of 186 patients with tSAH who underwent CTA, 13 (6.99%) had an aneurysm. Eight of these were ruptured aneurysms.
• All patients with ruptured aneurysms (100%) had CSH; none of the patients with unruptured aneurysms had CSH.
• Central subarachnoid hemorrhage, particularly suprasellar cistern hemorrhage, was a significant predictor of aneurysm presence (OR, 4.78).

Conclusions:

• Preliminary data support a selective approach to CTA screening in tSAH.
• CTA is recommended for patients with CSH, irrespective of injury mechanism.
• A more restrictive CTA approach may be suitable for patients with only peripheral subarachnoid hemorrhage.