Christoph Ziegenfuß, Natalie van Landeghem, Rosa Schubert, Aydin Demircioglu, Sibei Chen, Ramazan Jabbarli, Philipp Dammann, Ulrich Sure, Christoph Kleinschnitz, Michael Forsting, Isabel Wanke, Hanna Styczen, Cornelius Deuschl, Yan Li
Primitive BVR drainage is more frequent in PMNSAH than in propensity-score-matched angiographic controls, supporting a venous contribution to PMNSAH susceptibility. BVR variants have less relevance on initial hemorrhage burden or neurological sequela from admission to discharge.
PURPOSE: Variants of basal vein of Rosenthal (BVR), particularly the primitive drainage pattern, have been associated with the occurrence of perimesencephalic non-aneurysmal subarachnoid hemorrhage (PMNSAH). However, less is known about their impact on the initial hemorrhage burden and the neurological sequela of PMNSAH.
METHODS: This retrospective single-center study included 78 consecutive PMNSAH patients from 2002 to 2025 and 78 propensity-score-matched angiographic control patients selected from a pool of 117 controls. Variants of BVR were classified on DSA according to Watanabe classification; the maximum hemispheric type (BVR_max) was subcategorized. Hemorrhage burden at admission was quantified using a perimesencephalic modified Hijdra-based score (PM-mHSS). Neurological impairment of patients was assessed at admission with Glasgow Coma Scale, World Federation of Neurosurgical Societies, Hunt and Hess grading system and at discharge with modified Rankin Scale.
RESULTS: BVR drainage patterns differed between PMNSAH and propensity-score-matched controls, most pronounced for BVR_max (p=0.006). Primitive drainage (type 3) was more frequent in PMNSAH than in matched controls (47.4% vs 24.4%). In Bayesian ordinal regression models, variants of BVR did not correlate with severity of neurological impairment at admission, hemorrhage burden, or discharge mRS. Increasing age was independently associated with higher modified Fisher grade (OR 1.06; 95% CI, 1.01-1.10; p=0.02), higher PM-mHSS total (OR 1.06; 95% CI, 1.02-1.11; p=0.004), and worse discharge mRS (OR 1.06; 95% CI, 1.00-1.11; p=0.04).
CONCLUSION: Primitive BVR drainage is more frequent in PMNSAH than in propensity-score-matched angiographic controls, supporting a venous contribution to PMNSAH susceptibility. BVR variants have less relevance on initial hemorrhage burden or neurological sequela from admission to discharge.