小型の未破裂脳動脈瘤に外科的治療は必要か?

概要

論文の詳細を見る
There seems to be a general agreement that unruptured cerebral aneurysms measuring more than 10 mm should be treated surgically, although the situation regarding smaller lesions, especially those with a maximum diameter less than 5 mm, is more controversial. We analyzed operative findings of 122 unruptured cerebral aneurysms found in 92 surgical cases to estimate whether such small aneurysms are prone to rupture. Among the 122, 32 (26%) were evaluated as having thickwalled sacs (type 1), 54 (44%) partially or entirely thin-walled sacs (type 2), and 36 (30%) partially or entirely very thin-wall sacs so that intra-aneurysmal blood turbulence was visible through the aneurysmal walls (type 3). The sizes were 9.6+1.3 mm (mean + 1 SD) for type 1 aneurysms, 4.8 ± 0.3 mm for type 2, and 5.3 ±0.9 mm for type 3, types 2 and 3 aneurysms being significantly smaller than type 1 aneurysms. Eighty-three percent of unruptured aneurysms less than 5 mm in diameter had partially or entirely thin-walled sacs. Ninty-eight percent of patients with surgical treatment for unruptured aneurysms less than 5 mm showed good recovery. Assuming that thin-walled aneurysms are at a high risk of subsequent subarachnoid hemorrhage, prophylactic surgical treatment for small unruptured aneurysms in otherwise healthy individuals may be recommended.
日本脳卒中の外科学会の論文
2000-07-31