Czepko Ryszard, Rybak Mariusz, Potoczny Paweł, Kwinta Borys, Ossowski Piotr
Klinika Neurochirurgii Collegium Medicum, Uniwersytetu Jagiellońskeigo, Kraków.
Przegl Lek. 2004;61(5):477-81.
Multiple aneurysms of the brain are a more dangerous disorder than single aneurysms. Most of patients have evidence of aneurysmal rupture, but rebleeding remains an additional danger because of co-existing aneurysms. These "silent" aneurysms also have to be operated--the risk of following subarachnoid haemorrhage (SAH) is about 2% annually.
The purpose of this study was to assess of the surgical outcome in multiple aneurysmal SAH in regard to chosen risk factors.
Retrospective analysis of 608 patients treated within three years (2001-2003) for cerebral aneurysms in the Department of Neurosurgery, Jagiellonian University in Kraków, was carried out. 14% patients had multiple aneurysms: 72--two aneurysms, 10 patients three aneurysms, and three patients four and more. The mean age was 50, with slight predominance of women (58%). Most patients were operated on via pterional craniotomy, and posterior circulation aneurysms were clipped by means of suboccipital approach. "Silent" aneurysms being clipped in the first stage, if were available via the same craniotomy, another--in the next stage. We analyzed short-term outcome of multiple aneurysms in comparison to the single (literature data). We presented the outcome (according to the Glasgow Outcome Scale) with regard to preoperative condition, age, location of the most frequent "bleeding" aneurysms (middle cerebral artery, anterior communicating artery), and in patients operated on in the 1st and 2nd stage. Accuracy of the preoperative detection of "bleeding" aneurysm was checked based on CT, MRI, angio-CT, angio-MRI and DSA.
Out of all 85 treated patients, 64 (75.3%) presented very good and good condition on discharge. Five (5.9%) were severe disabled, and 16 (18.8%) died. Good preoperative condition, age less than 55, and "bleeding" aneurysms of the middle cerebral artery (compared with anterior communicating artery) are good prognostic factors in surgically treated multiple aneurysms. Outcome in single and multiple aneurysms is similar, excluding perioperative losses, which are 5% higher in the multiple aneurysms group. In our series in each case of "bleeding" aneurysm was correctly detected preoperatively.
脑多发性动脉瘤是一种比单发性动脉瘤更危险的疾病。大多数患者有动脉瘤破裂的证据，但由于并存的动脉瘤，再出血仍是一个额外的危险因素。这些“无症状”动脉瘤也必须进行手术——每年发生蛛网膜下腔出血（SAH）的风险约为2%。
本研究的目的是评估与选定危险因素相关的多发性动脉瘤性SAH的手术结果。
对雅盖隆大学克拉科夫分校神经外科在三年（2001 - 2003年）内治疗的608例脑动脉瘤患者进行回顾性分析。14%的患者有多发性动脉瘤：72例有两个动脉瘤，10例有三个动脉瘤，3例有四个及更多动脉瘤。平均年龄为50岁，女性略占优势（58%）。大多数患者通过翼点入路进行手术，后循环动脉瘤通过枕下入路夹闭。“无症状”动脉瘤如果可通过同一切口在第一阶段夹闭，另一个则在第二阶段夹闭。我们将多发性动脉瘤的短期结果与单发性动脉瘤（文献数据）进行了比较。我们根据格拉斯哥预后量表呈现了关于术前状况、年龄、最常见“出血”动脉瘤的位置（大脑中动脉、前交通动脉）以及在第一阶段和第二阶段接受手术的患者的结果。基于CT、MRI、血管造影CT、血管造影MRI和DSA检查术前检测“出血”动脉瘤的准确性。
在所有85例接受治疗的患者中，64例（75.3%）出院时状况非常良好。5例（5.9%）严重残疾，16例（18.8%）死亡。术前状况良好、年龄小于55岁以及大脑中动脉的“出血”动脉瘤（与前交通动脉相比）是手术治疗多发性动脉瘤的良好预后因素。单发性和多发性动脉瘤的结果相似，但围手术期损失除外，多发性动脉瘤组高5%。在我们的系列研究中，每例“出血”动脉瘤术前均被正确检测。
