未破裂脳動脈瘤 : その新しい概念について
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概要
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Thirty outpatients with unruptured cerebral aneurysms were screened by noninvasive cerebral computed angiotomography at Matsuyama Shimin Hospital between 1979 and 1984. Seventeen were male and 13 were female. The ages at diagnosis ranged from 41 to 74 years (mean, 57.7 years), and their distribution was as follows: seven were 40 to 49 years, 10 were 50 to 59 years, 10 were 60 to 69 years, and three were over 70 years. Clinical problems were: headaches in eight, neurological deficits in 11, seizure in three, and tinnitus in one. These clinical problems were mild and unrelated to screened unruptured aneurysms in all. Six had a personal or family history of apoplexy. One was screened during the medical checkup in human dock. Thirty patients had 32 aneurysms; four were on internal carotid arteries, eight were on anterior cerebral arteries (one was distal anterior cerebral artery aneurysm and seven were anterior communicating artery aneurysms), 14 were on middle cerebral arteries, two were on posterior cerebral arteries, and four were on vertebro-basilar tree. The size of aneurysms varied; being 5 mm in eight patients, 6 mm in five, 8 and 9 mm in three each, 4, 7, 10, 13, and 22 mm in two each, and 18, 20, and 29 mm in one each. The aneurysms less than 10 mm in size were 78.1%. Thus, unruptured cerebral aneurysms in the critical range of rupture could be screened by the noninvasive method. In the 15 patients who did not receive operation, eight showed no change of condition, two worsened and four expired due to other causes, and one expired as a result of aneurysmal rupture. Of the 15 patients who were operated on, 11 showed no neurological morbidity and three had transient minor neurological symptoms postoperatively, and one experienced acute cardiac infarction 1 month after operation. The longterm results showed 10 patients in good condition, two in deteriorated conditions, and three who expired due to other causes. The results show that these unruptured cerebral aneurysms should belong to a new category of unruptured cerebral aneurysms. Generally, unruptured cerebral aneurysms, once discovered, should be operated on from the standpoint of prevention of the subarachnoid hemorrhage. However, the indication for surgery is still controversial.
- 日本脳神経外科学会の論文
- 1986-10-15
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