Inagawa T, Hirano A
Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
Surg Neurol. 1990 Feb;33(2):117-23. doi: 10.1016/0090-3019(90)90020-p.
The autopsy findings of 133 patients with ruptured intracranial aneurysms were reviewed: 24 (18%) had multiple aneurysms. Intraventricular hemorrhage was seen in 53 patients (40%), and intracerebral hematoma was seen in 52 (39%). Intraventricular hemorrhage was seen most frequently in patients with anterior communicating artery aneurysms [21 of 40 (53%)]. Intracerebral hematoma occurred most frequently in patients with middle cerebral artery aneurysms [11 of 28 (39%)]. Hemorrhages arising from anterior communicating artery aneurysms had two types of penetration routes into the lateral ventricle. The first was through the inferomedial portion of the frontal lobe, and the second was through the corpus callosum. The second type was poorly visualized in horizontal sections of the brain. Of 40 patients with anterior communicating artery aneurysms, the first type of penetration route was observed in 15, and the second type was found in 3. The second type is rare, and if the hemorrhage is not massive, it may be overlooked in axial computed tomography scans. Of the 109 ruptured aneurysms, 18 (17%) were 4 mm or less in diameter, 50 (46%) were 5-9 mm in diameter, and 41 (38%) were 10 mm or larger in diameter. In the 21 patients with multiple aneurysms, unruptured aneurysms were smaller than ruptured aneurysms in 17 of 27 (63%), equal size in 9 (33%), and larger in 1 (4%). Regarding rerupture, the larger the ruptured aneurysms were, the higher the percentage of rerupture, that is, 11% of 18 ruptured aneurysms of 4 mm or less in diameter, 32% of 50 of 5-9 mm in diameter, and 37% of 41 of 10 mm or larger in diameter had reruptured. It seems that the larger the size of the aneurysm, the higher the risk of rerupture as well as of initial rupture.
回顾了133例颅内动脉瘤破裂患者的尸检结果：24例（18%）有多个动脉瘤。53例患者（40%）出现脑室内出血，52例（39%）出现脑内血肿。脑室内出血最常见于前交通动脉瘤患者[40例中有21例（53%）]。脑内血肿最常见于大脑中动脉瘤患者[28例中有11例（39%）]。前交通动脉瘤引起的出血有两种进入侧脑室的穿透途径。第一种是通过额叶的内下部分，第二种是通过胼胝体。第二种类型在脑部水平切片中显示不佳。在40例前交通动脉瘤患者中，观察到第一种穿透途径的有15例，第二种类型的有3例。第二种类型很罕见，如果出血不严重，在轴向计算机断层扫描中可能会被忽视。在109个破裂的动脉瘤中，18个（17%）直径为4毫米或更小，50个（46%）直径为5 - 9毫米，41个（38%）直径为10毫米或更大。在21例有多个动脉瘤的患者中，27例中有17例（63%）未破裂的动脉瘤比破裂的动脉瘤小，9例（33%）大小相等，1例（4%）更大。关于再破裂，破裂的动脉瘤越大，再破裂的百分比越高，即直径4毫米或更小的18个破裂动脉瘤中有11%再破裂，直径5 - 9毫米的50个中有32%再破裂，直径10毫米或更大的41个中有37%再破裂。似乎动脉瘤越大，再破裂以及初次破裂的风险就越高。
