Blick in die Tiefe: Untersuchung der infratentoriellen peritrunkalen Blutunganteilen und deren Auswirkungen auf das Outcome bei aneurysmatischen Subarachnoidalblutungen

Despite the crucial roles played by the brain stem, prevailing radiological outcome scores for aneurysmal subarachnoid hemorrhage (aSAH) primarily focus on supratentorial blood components (e.g. the mFisher score). We propose that infratentorial peritruncal blood, often overlooked, may also impact patient outcomes post-aSAH. This study aims to investigate possible connections between infratentorial peritruncal blood in aSAH and patient outcomes, with the goal of identifying opportunities to improve existing prognostic scores.

We retrospectively analyzed infratentorial cisternal and ventricular blood volumes (including Cisternae interpeduncularis, praepontina, praemedullaris, magna, and Ventriculi tertius and quartus) in 526 aSAH patients. Correlations with trichotomized outcomes (modified Rankin Scale (mRS) at discharge and after 6 months: good≤2; poor=3-5; dead=6) were assessed. Individual cisternal blood volumes, the sum of intraventricular blood, total infratentorial blood volume (all measured cisterns and ventricles), and a simplified unweighted infratentorial bleeding score (total score: presence of bleeding in a ventricle or cistern→1 point; Range 0-6) were examined. The diagnostic utility of the unweighted infratentorial bleeding score, considering age, mFisher score, and WFNS score, was explored using logistic regression.

The volume of each individual infratentorial cistern exhibited a significant correlation with outcomes at discharge and after 6 months (both p<0.001). Total infratentorial cisternal and ventricular blood volumes (in ml±SD; good=5.5±3.0; poor=7.8±2.6; dead=8.7±2.2; p<0.001 at discharge / post 6 months) and infratentorial ventricular blood volume (in ml±SD; good=1.2±1.7; poor=2.5±1.8; dead=3.1±1.7; p<0.001 at discharge / post 6 months) demonstrated a significant association with poorer outcomes. The simplified unweighted infratentorial bleeding score also significantly correlated with outcomes at discharge (p>0.001) and after 6 months (p=0.046), with logistic regression just falling short of statistical significance (p=0.056).

The study suggests that the volume of infratentorial peritruncal hemorrhage in aSAH significantly impacts outcomes. Even a simplified unweighted infratentorial bleeding score shows nearly comparable prognostic effectiveness to established scores like mFisher and WFNS. Exploring infratentorial peritruncal blood volume in aSAH patients has the potential to enhance the current clinical utility of Fisher scores.