未破裂前交通动脉瘤的破裂风险：自然史研究的荟萃分析
Risk of rupture in unruptured anterior communicating artery aneurysms: meta-analysis of natural history studies.
作者信息
Mira Juan Marcos Suárez, Costa Fernando Antonio De Oliveira, Horta Bernardo Lessa, Fabião Othello Moreira
机构信息
Departamento de Neurocirurgia, Hospital Santa Casa de Misericórdia, Santana do Livramento, Rio Grande do Sul, Brazil.
出版信息
Surg Neurol. 2006;66 Suppl 3:S12-9; discussion S19. doi: 10.1016/j.surneu.2006.06.025.
BACKGROUND
The decision of whether to operate on patients bearing UIAs is complicated by the limitations in current knowledge of the natural history of such lesions. The ISUIA has estimated the annual risk of rupture below that justifying surgery for most incidentally found lesions less than 7 mm in diameter. However, there is some evidence that aneurysms located in the ACoA show a higher risk of rupture, even with diameters of less than 7 mm. The present study was conducted to investigate the risk of aneurysm rupture in this site.
METHODS
The available literature on the subject was thoroughly reviewed, and a meta-analysis was carried out comparing the risk of rupture of aneurysms found in the ACoA with that of aneurysms in other sites.
RESULTS
Aneurysms found unruptured in the ACoA show a risk of rupture twice as high as that of other intracranial aneurysms (95% confidence interval, 1.29-3.12). It is the first time this fact has been demonstrated based on the follow-up of unruptured aneurysms.
CONCLUSION
When deciding whether to operate on UIAs located in the ACoA, surgeons should consider their higher risk of rupture.
背景
对于患有未破裂颅内动脉瘤（UIA）的患者是否进行手术的决策，因目前对此类病变自然史的认识有限而变得复杂。国际未破裂颅内动脉瘤研究（ISUIA）估计，对于大多数偶然发现的直径小于7毫米的病变，其每年的破裂风险低于足以证明手术合理性的水平。然而，有一些证据表明，位于前交通动脉（ACoA）的动脉瘤即使直径小于7毫米，其破裂风险也更高。本研究旨在调查该部位动脉瘤破裂的风险。
方法
对关于该主题的现有文献进行了全面回顾，并进行了一项荟萃分析，比较ACoA中发现的动脉瘤与其他部位动脉瘤的破裂风险。
结果
在ACoA中发现的未破裂动脉瘤的破裂风险是其他颅内动脉瘤的两倍（95%置信区间，1.29 - 3.12）。这是首次基于对未破裂动脉瘤的随访证明这一事实。
结论
在决定是否对位于ACoA的UIA进行手术时，外科医生应考虑其更高的破裂风险。
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