硬膜内巨大脳動脈瘤の自然経過と治療戦略

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We retrospectively analyzed clinical courses of 69 giant intradural aneurysms before treatments in 68 patients who admitted to our institute between April 1965 and December 1998 in order to determine the natural history of intradural giant aneurysms. The aneurysms were located on the internal carotid artery in 31, the middle cerebral artery in 9, the anterior cerebral artery in 9, the posterior cerebral artery in 2, the basilar artery in 14, and the vertebral artery in 4. Sixteen presented with hemorrhage, 35 with mass signs, and 18 with others (headache in 7, seizure in 4, embolism in 2, asymptomatic in 5). Between the initial presentation and the treatment (0-360 months), 11 hemorrhages occurred in 69 aneurysms, and 5 were fatal (annual bleeding rate 5.2%, annual death rate 2.4%). Re-bleedings occurred in 7 out of 16 hemorrhagic cases (fatal in 3) during 0-360 months of follow up periods. In 35 massive aneurysms, mass signs remained progressive in 28 and bleeding occurred in 3 (fatal in 1) during 1-288 months of follow up periods. In 18 aneurysms without hemorrhage or mass signs as initial symptoms, bleeding occurred in 1 (fatal) during 1-264 months of follow-up periods. The presence of thrombosis did not prevent subarachnoid hemorrhage. Giant intradural aneurysms with hemorrhage or mass signs should be treated considering high risks of re-bleeding in ruptured cases and progressive neurological deficits in massive cases, and those without hemorrhage or mass signs should be treated depending on the progression of symptoms and surgical morbidities.
日本脳卒中の外科学会の論文
2000-05-31

硬膜内巨大脳動脈瘤の自然経過と治療戦略

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