Treatment Selection for Ruptured Aneurysm and Outcomes : Clipping or Coil Embolization
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概要
- 論文の詳細を見る
The International Subarachnoid Aneurysm Trial has shown that coil embolization achieves a better outcome for aneurysms treatable by either clipping or coil embolization. However, many ruptured aneurysms are hardly treatable by either clipping or coil embolization. Selection of either clipping or coil embolization will affect the treatment outcome for ruptured aneurysms. The relationship between patient selection and treatment outcome in a so-called “regional center hospital” in Japan must be clarified. This study included 113 patients with ruptured intracranial saccular aneurysms measuring less than 10 mm. Selection criteria for coil embolization were principally paraclinoid or posterior circulation aneurysm, Hunt and Hess grade IV or over, and patient age 75 years or older. Other aneurysms were principally treated by clipping. Aneurysms with a dome/neck ratio of less than 1.5, distorted aneurysms, Hunt and Hess grades I-III, patient age 74 years or younger, and middle cerebral artery aneurysm were actively treated by clipping. A few exceptional indications were considered in detail. Low invasiveness coil embolization is better than clipping to obtain good neurological outcome for patients with perforators difficult to dissect, aneurysms difficult to dissect due to previous open surgery, and aneurysms requiring bilateral open surgery, despite the slightly higher rebleeding rate in coil embolization. Overall outcomes were modified Rankin Scale (mRS) 0-2 in 82 of 113 patients (73%) and mRS 3-6 in 31 (27%). Appropriate selection of clipping or coil embolization can achieve acceptable treatment outcomes for ruptured aneurysm.
- 2011-01-15
著者
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UMEBAYASHI Daisuke
Department of Neurosurgery, Kyoto Second Red Cross Hospital
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TAKADOU Michiko
Department of Neurosurgery, Kyoto Second Red Cross Hospital
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KUBO Satoshi
Department of Neurosurgery, Kyoto Second Red Cross Hospital
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Kubo Satoshi
Department Of Biomass Chemistry Forestry And Forest Products Research Institute
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Mandai Ayako
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Osaka Yasuhiko
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Tenjin Hiroshi
Department Of Neurosurgery Kyoto Prefectural University Of Medicine
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Tenjin Hiroshi
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Ogawa Takahiro
Department Of Biological Science And Technology Science University Of Tokyo
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Nakahara Yoshikazu
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Nakahara Yoshikazu
Department Of Neurosurgery Kyoto Prefectural University Of Medicine
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Umebayashi Daisuke
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Kubo Satoshi
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Ogawa Takahiro
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Takadou Michiko
Department Of Neurosurgery Kyoto Second Red Cross Hospital
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Kubo Satoshi
Department Of Biological And Environmental Science Faculty Of Agriculture Graduate School Of Agricul
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Mandai Ayako
Department Of Neurosurgery Japanese Red Cross Kyoto Daini Hospital
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Tenjin Hiroshi
Department Of Neurosurgery Japanese Red Cross Kyoto Daini Hospital
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Nakahara Yoshikazu
Department Of Neurosurgery Japanese Red Cross Kyoto Daini Hospital
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Osaka Yasuhiko
Department Of Neurosurgery Japanese Red Cross Kyoto Daini Hospital
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Takadou Michiko
Department Of Neurosurgery Japanese Red Cross Kyoto Daini Hospital
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