What does this research mean for the field?

In patients with perimesencephalic subarachnoid hemorrhage and negative initial high-quality computed tomography angiography, routine repeat digital subtraction angiography is unjustified because its procedural complication rate exceeds its diagnostic yield. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the diagnostic yield and procedural risk of digital subtraction angiography and assess whether initial hemorrhage volume predicts functional outcomes in perimesencephalic subarachnoid hemorrhage.

September 3, 2026Neurosurgery

Hemorrhage Volume and Imaging Recommendations: Factors for Decision Making in the Care of Patients With Perimesencephalic Subarachnoid Hemorrhage

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To evaluate the diagnostic yield and procedural risk of digital subtraction angiography and assess whether initial hemorrhage volume predicts functional outcomes in perimesencephalic subarachnoid hemorrhage.
Retrospectively analyzed 279 consecutive patients with perimesencephalic subarachnoid hemorrhage treated at two tertiary neurosurgical centers between 1999 and 2021.
Assessed vascular imaging modalities (CTA in 91.0%, DSA in 71.3%, MRA in 19.7%), procedural complications, discharge modified Rankin Scale, and noncontrast CT-derived hemorrhage volume.
Vascular pathology was identified in only 1 patient (0.4%) following clinical deterioration, while procedure-related ischemic complications occurred in 7 patients (2.5%), causing permanent neurological deficit in 1 patient (0.4%).
A 13-mL hemorrhage volume threshold separated poor from favorable discharge outcome with an area under the curve of 0.826, specificity of 0.88, and negative predictive value of 0.97.

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Implication

Retrospective cohort study reveals that angiography risks outweigh diagnostic yield in perimesencephalic subarachnoid hemorrhage, indicating routine repeat invasive imaging is unjustified.

Cite This Study

Preuss-Hernández et al. (2026) studied this question.

synapsesocial.com/papers/6a993653636c6408cfa7f4ea https://doi.org/10.1227/neu.0000000000004192

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Implication

Retrospective cohort study reveals that angiography risks outweigh diagnostic yield in perimesencephalic subarachnoid hemorrhage, indicating routine repeat invasive imaging is unjustified.

Hemorrhage Volume and Imaging Recommendations: Factors for Decision Making in the Care of Patients With Perimesencephalic Subarachnoid Hemorrhage

Key Points

Discussion

Implication

Cite This Study

Hemorrhage Volume and Imaging Recommendations: Factors for Decision Making in the Care of Patients With Perimesencephalic Subarachnoid Hemorrhage

Key Points

Discussion

Implication

Cite This Study

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