Tsukahara T, Murakami N, Sakurai Y, Yonekura M, Takahashi T, Inoue T, Yonekawa Y
Department of Neurological Surgery and Clinical Research Center, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
Acta Neurochir Suppl. 2005;94:77-85. doi: 10.1007/3-211-27911-3_12.
The treatment and natural course of unruptured cerebral aneurysms were analyzed in 615 patients with 712 unruptured cerebral aneurysms registered from seven Japanese national hospitals and Zurich University hospital. For 209 aneurysms in 181 cases, the natural course of the aneurysms was observed without surgical treatment. During the follow-up period of 3,862 months (321.8 years), 11 of these aneurysms ruptured giving a rupture rate of 3.42%/year. Five of these 11 aneurysms were less than 10 mm in diameter. Seventeen aneurysms of these 209 untreated aneurysms had blebs. Seven of these 17 aneurysms ruptured yielding the high rupture rate of 28.3%/year. The likelihood of unruptured cerebral aneurysms to rupture was not exceedingly low even when the aneurysms were smaller than 10 mm. Since the risk of rupture and morbidity in relation to surgical treatment cannot be predicted by size alone, the morphology, especially the presence of blebs, should be considered when treating unruptured cerebral aneurysms. In 434 patients, 503 cerebral aneurysms were treated surgically either by craniotomy in 472 aneurysms or endovascular coil embolization in 31 aneurysms. Surgical outcome was influenced by the presence of concurrent diseases, patient age, size and location of the aneurysms. Complications after surgical treatment of 128 incidentally found aneurysms were reported in four cases; three cases of hemiparesis and one case showing disturbance of higher brain function, with a morbidity rate of 3.1%. These results suggest that surgical treatment may be acceptable in cases of incidentally found cerebral aneurysms, especially when blebs are present.
对来自七家日本国立医院和苏黎世大学医院登记的615例患者的712个未破裂脑动脉瘤的治疗情况及自然病程进行了分析。在181例患者的209个动脉瘤中，未进行手术治疗，而是观察动脉瘤的自然病程。在3862个月（321.8年）的随访期内，其中11个动脉瘤破裂，破裂率为每年3.42%。这11个破裂的动脉瘤中有5个直径小于10毫米。这209个未经治疗的动脉瘤中有17个有瘤泡。这17个有瘤泡的动脉瘤中有7个破裂，破裂率高达每年28.3%。即使动脉瘤小于10毫米，未破裂脑动脉瘤破裂的可能性也并非极低。由于仅根据大小无法预测与手术治疗相关的破裂风险和发病率，因此在治疗未破裂脑动脉瘤时应考虑其形态，尤其是瘤泡的存在情况。在434例患者中，对503个脑动脉瘤进行了手术治疗，其中472个动脉瘤采用开颅手术，31个动脉瘤采用血管内线圈栓塞术。手术结果受合并疾病、患者年龄、动脉瘤大小和位置的影响。报告了4例128个偶然发现的动脉瘤手术治疗后的并发症；3例偏瘫，1例高级脑功能障碍，发病率为3.1%。这些结果表明，对于偶然发现的脑动脉瘤，尤其是存在瘤泡的情况，手术治疗可能是可以接受的。
