Anatomical variants of the basal vein of Rosenthal: prevalence in idiopathic subarachnoid hemorrhage

Abstract

Previous studies displayed a significant prevalence of BVR type C variants in ISAH. Conversely in our study we recognized variant B as prevalent, in which the BVR bifurcates to drain anteriorly into the uncal vein and posteriorly into the Galenic system. Similarly to variant C (in which the BVR drains via perimesencephalic "bridging" veins into cavernous, sphenoparietal, petrosal sinus or directly into transverse sinus) also variant B might be subjected to those stress mechanisms and intrinsic system 'fragility' and for reasons yet to determine, sets off a consequent hemorrhage with clinical and radiological features typical of ISAH.

Quadrigeminal perimesencephalic subarachnoid hemorrhage

“…These clinical similarities suggest that both patterns of hemorrhage are due to a non-arterial source [2]. An association between pretruncal nonaneurysmal PSAH and abnormal venous anatomy has led to the hypothesis that the etiology is a venous rupture secondary to central cerebral venous hypertension [15][16][17][18]. For example, patients with pretruncal nonaneurysmal PSAH are more likely to have variant Basal vein of Rosenthal drainage into a dural venous sinus via a perimesencephalic bridging vein [21].…”

Angiographic assessment of variants of basal vein of Rosenthal in idiopathic subarachnoid hemorrhage

“…Because failure of anastomosis is most frequent between the first and second segment, type B is a common variant of type A [11]. The mechanism suggested is that the veins might be torn by way of the direct connection of perimesencephalic veins with the dural sinuses with intracranial venous congestion, or sudden swelling of the tributaries of the BVR among patients with anomalous venous drainage [3,4]. Song et al reviewed 57 patients with ISAH, normal drainage (AA) 28.1% patients, 22.8% patients with normal variants (AB, or BB) and 49.1% patients with a primitive pattern (CA, CB, CC) found.…”

“…Spontaneous SAH is generally caused by rupture of an aneurysm, although DSA could not locate the cause of bleeding in about 15% of patients with spontaneous SAH [2,3,8]. In a subtype of DSA negative SAH patients the blood is placed in the cisterns around the mid-brain and the center of bleeding is anterior to the mid-brain in 21-68% of the ISAH cases known to have perimesencephalic SAH (PMSAH) [9][10][11].…”

“…In approximately 15% of cases, neither aneurysm nor other vascular malformation can be identified by cerebral angiography; in this case it is defined as idiopathic SAH (ISAH) [1,2]. ISAH have a benign clinical course and a much better outcome than patients with aneurysmal SAH [1,3]. In the literature, studies have suggested a possible contribution by primitive variants of Basal vein of Rosenthal (BVR) in the pathogenesis of ISAH [2,4,5].…”

Indocyanine green video-angiography in neurosurgery: A glance beyond vascular applications

“…The first minutes and hours after SAH are predictive of overall outcome and important for the prognosis [68][69]. Cerebral blood flow (CBF) changes appear to play a pivotal role in the acute phase, but intraoperative estimation of CBF still poses a significant challenge, whileat the same time, it could potentially influence and improve clinical management [68,70]. Shubert et al [68] recently published their research on the use of cortical ICG in the setting of acute SAH as it provides evidence of acute vasoconstriction after emorrhage, but more importantly provides a measurement of CBF intraoperatively (by means of measurement of reflected tissue signal analyzed using the Flow 800 software analysis tool) [68].…”