Grigorian Arthur A, Marcovici Alvin, Flamm Eugene S
Georgia Neurological Institute, Macon, Georgia, USA.
J Neurosurg. 2003 Sep;99(3):452-7. doi: 10.3171/jns.2003.99.3.0452.
Some well-known predictors of clinical outcomes in patients with ruptured aneurysms are not useful for forecasting outcome in patients with unruptured aneurysms. The goal of this study was to analyze outcomes in patients harboring unruptured cerebral aneurysms in different locations and to create a predictive tool for assessing both favorable outcome and morbidity in a large series of unruptured aneurysms.
The authors analyzed data from 387 patients with nonruptured intracranial cerebral aneurysms who underwent surgery for clip placement. Intraoperative data were reviewed and seven factors that might influence outcomes were identified. These included the following: 1) aneurysm size larger than 10 mm; 2) presence of a broad aneurysm neck; 3) presence of plaque calcification near the aneurysm neck; 4) application of clips to more than one aneurysm during the same surgery; 5) temporary occlusion; 6) multiple clip applications and repositioning; and 7) use of multiple clips. The entire group of patients with unruptured aneurysms was divided into two subgroups on the basis of outcome. Each patient was subsequently assessed to formulate the factor accumulation index (FAI), the sum of different factors observed in a given patient. The subgroup of patients with expected outcomes was composed of 312 patients, whereas the subgroup of unexpected outcomes consisted of 31 patients. Depending on the anatomical locations of the aneurysms, the combined mortality-morbidity rate ranged from 5.7 to 25%, with the best results for patients harboring ophthalmic artery aneurysms and the worst results for those with vertebrobasilar system (VBS) aneurysms. The majority of patients with expected outcomes who harbored aneurysms of the middle cerebral artery, the internal carotid artery, and the VBS had a lower FAI, whereas the majority of patients with unexpected outcomes had a higher FAI.
It is possible to predict outcomes in patients with unruptured cerebral artery aneurysms by calculating the FAI. The rate of postoperative morbidity increases with the FAI within the range of three to four factors.
一些已知的破裂动脉瘤患者临床预后预测指标对未破裂动脉瘤患者的预后预测并无用处。本研究的目的是分析不同部位未破裂脑动脉瘤患者的预后，并创建一种预测工具，用于评估大量未破裂动脉瘤患者的良好预后和发病率。
作者分析了387例接受夹闭手术的未破裂颅内脑动脉瘤患者的数据。回顾术中数据，确定了七个可能影响预后的因素。这些因素包括：1）动脉瘤大小大于10mm；2）存在宽颈动脉瘤；3）动脉瘤颈部附近存在斑块钙化；4）同一手术中对多个动脉瘤应用夹子；5）临时阻断；6）多次应用夹子和重新定位；7）使用多个夹子。根据预后将整个未破裂动脉瘤患者组分为两个亚组。随后对每位患者进行评估，以制定因素累积指数（FAI），即给定患者中观察到的不同因素之和。预期预后患者亚组由312例患者组成，而意外预后亚组由31例患者组成。根据动脉瘤的解剖位置，合并死亡率-发病率在5.7%至25%之间，眼动脉动脉瘤患者的结果最佳，椎基底动脉系统（VBS）动脉瘤患者的结果最差。大多数预期预后且患有大脑中动脉、颈内动脉和VBS动脉瘤的患者FAI较低，而大多数意外预后患者的FAI较高。
通过计算FAI可以预测未破裂脑动脉瘤患者的预后。术后发病率随着三到四个因素范围内的FAI增加而升高。
