未破裂無症候性脳動脈瘤の治療指針

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Management decisions in patients with asymptomatic unruptured aneurysms require accurate assessment of the risk: benefit ratio of various treatment options compared to the natural history of the disease. We analyzed the risks associated with aneurysmal surgery and risk of rupture in 84 patients with asymptomatic unruptured aneurysms experienced between 1990 and 1999 at Tokyo Women's Medical University. Thirty-six aneurysms were located at the internal carotid, 25 at the anterior cerebral, 35 at the middle cerebral, and 8 at the vertebro-basilar artery. Sixty-nine aneurysms in 58 patients were treated surgically (60 aneurysms were clipped, 8 coated, and one embolized). Permanent mortality occurred in 6 patients, a major cause of which was cerebral infarction due to perforator vessel injury. Presenting symptoms of intracerebral hematoma and multiple lacunar infarctions were associated in 2 patients. One patient was over 80 years old. A follow-up study was done with 25 aneurysms in 25 patients. The median follow-up time was 3.2 years (0.1-8.6 years). There were 6 episodes of hemorrhage, giving an average annual rupture incidence of 7.5%. Five of these bleeding episodes were fatal (mortality: 83%). Four aneurysms were >11 mm. In conclusion, the relatively high incidence of surgical morbidity depended on perforator vessel injury. The patient's age and presenting symptoms of cerebrovascular disease seemed to be associated with increased operative morbidity. The high risk of rupture followed by death was noted in a follow-up period in patients with asymptomatic unruptured aneurysm.
日本脳卒中の外科学会の論文
2001-07-31

未破裂無症候性脳動脈瘤の治療指針

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