Yoneoka Y, Takeda N, Akira I, Ibuchi Y, Kumagai T, Sugai T, Takeda K-I, Ueda K
Department of Neurosurgery, Yamagata Prefecture Central Hospital, 1800 Aoyagi, Yamagata 990-2292, Japan.
Acta Neurochir (Wien). 2004 Sep;146(9):979-81; discussion 981. doi: 10.1007/s00701-004-0308-2. Epub 2004 Jun 28.
We describe the actual state of ruptured de novo intracranial aneurysms to contribute to a guideline of follow-up for the patients with treated intracranial aneurysm.
The authors retrospectively investigated 12 cases drawn from 483 consecutive cases of aneurysmal subarachnoid hemorrhage at our institute over a period of 22 years, in which a previously undemonstrated (hence "de novo") intracranial saccular aneurysm formed and ruptured after successful treatment of a prior aneurysm.
The 12 cases constitute 2.5% of the 483 patients who left our hospital alive. Eleven cases were females and one was a male with a mean age of 55.7 years (range 29-75) at the first subarachnoid haemorrhage (SAH) and an interval between the first and the second rupture of 10.7 years (range: 2.6-23.8, standard deviation: 6.86, 95% confidence interval: 6.39-15.1). Four cases did not have risk factors such as hypertension, family history, smoking, multiple aneurysms, and moyamoya disease. None of these ruptured de novo aneurysms was at the same location as the original lesion. One-third (4 cases) of the de novo lesions in our series were found on the opposite side to each prior lesion.
For not only young but also elder patients with a treated aneurysm (from the fifth decade to the sixth), especially for women, late angiography or alternative modalities of less-invasive examination should be considered. To detect de novo intracranial aneurysms before rupture, the search for a de novo aneurysm should be performed within 6.39 years after a previous examination that shows an aneurysm to be nonexistent, in view of the 95% confidence interval of the mean time to de novo aneurysmal rupture (6.39-15.1 years). If applied this survey, 75% (8 cases of 12 cases) of our de novo aneurysms would be detected before rupture.
我们描述初发性颅内动脉瘤破裂的实际情况，以有助于制定颅内动脉瘤治疗后患者的随访指南。
作者回顾性研究了22年间我院483例连续的动脉瘤性蛛网膜下腔出血病例中的12例，这些病例中先前未显示（因此为“初发性”）的颅内囊状动脉瘤在先前动脉瘤成功治疗后形成并破裂。
这12例病例占483例出院存活患者的2.5%。11例为女性，1例为男性，首次蛛网膜下腔出血（SAH）时的平均年龄为55.7岁（范围29 - 75岁），首次和第二次破裂之间的间隔为10.7年（范围：2.6 - 23.8年，标准差：6.86，95%置信区间：6.39 - 15.1年）。4例没有高血压、家族史、吸烟、多发动脉瘤和烟雾病等危险因素。这些初发性破裂动脉瘤均不在原病变的同一位置。我们系列中的三分之一（4例）初发性病变位于每个先前病变的对侧。
对于已治疗动脉瘤的患者，不仅是年轻患者（从五十多岁到六十岁），尤其是女性患者，应考虑进行晚期血管造影或侵入性较小的替代检查方式。鉴于初发性动脉瘤破裂的平均时间的95%置信区间（6.39 - 15.1年），为了在破裂前检测到初发性颅内动脉瘤，应在先前检查显示动脉瘤不存在后的6.39年内进行初发性动脉瘤的筛查。如果应用此调查，我们12例初发性动脉瘤中的75%（8例）将在破裂前被检测到。
