Subarachnoid Haemorrhage from Spinal Tumours – a Systematic Review of the Literature

Introduction: Spinal subarachnoid haemorrhage (SSAH) originating from spinal tumours is a rare entity that may lead to cauda equina syndrome or spinal cord compression with the potential to extend along the entire length of the subarachnoid space.

Methods: A systematic review following PRISMA guidelines was conducted, searching MEDLINE, Embase, Web of Science, and Cochrane databases from January 1997-2024.

Results: A total of 3,794 papers were retrieved. This review analyzed 48 cases of SSAH from 41 included studies. Patients averaged 40.7 years, with 62.5% male. Symptoms were both cranial and spinal in 48% of cases, spinal-only in 44%, and spontaneous in 81%. Diagnosis primarily used lumbar puncture (40%) and MRI (38%). Tumors included ependymomas (40%), schwannomas (25%), and hemangioblastomas (19%), with three cases showing intratumoral hemorrhage. Surgery, mainly laminectomy, was performed in 86% of cases. Outcomes indicated 60% full recovery, 17% severe deficits, 13% mild deficits, and two deaths from comorbidities. Findings highlight the importance of timely diagnosis and surgical intervention in SSAH.

Conclusion : This study represents the first systematic review of SSAH from spinal tumours. Spinal tumours presenting with SAH may manifest with a spectrum of cranial/cerebral symptoms and SAH on cerebral/cranial neuroradiological investigations. A comprehensive understanding of these presentations is crucial for timely diagnosis and appropriate management.