Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
J Neurosurg. 2013 Jan;118(1):58-62. doi: 10.3171/2012.9.JNS111512. Epub 2012 Oct 12.
A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH).
A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976-2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors.
Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011).
While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.
一小部分患者在发现初始动脉瘤后会出现全新或新发的动脉瘤。这些病变的自然史尚不清楚。作者对大量破裂和未破裂的新发动脉瘤患者进行了这项统计评估，目的是分析破裂的危险因素，并估计蛛网膜下腔出血（SAH）的风险。
对 Goodman Campbell 大脑与脊柱血管神经外科服务中心 1976 年至 2010 年期间治疗的所有动脉瘤患者的前瞻性维护数据库进行了回顾。在 4718 名患者中，有 611 名（13%）进行了长期随访影像学检查。作者从常规监测影像学检查中发现了 27 名（4.4%）新发未破裂的动脉瘤患者，总共 32 个。他们又发现了 10 名患者在治疗原发性动脉瘤后出现新发 SAH 来自新发的动脉瘤。因此，总研究组有 37 名患者，共 42 个新发动脉瘤。然后，作者将 27 名偶然发现的动脉瘤患者与 10 名出现新发 SAH 的患者进行比较。对 2 组患者的特征和危险因素进行了统计学分析。
共发现 37 例真正的新发动脉瘤患者。该组女性居多，吸烟者比例较高。这 37 名患者共有 42 个新发动脉瘤。其中 10 个动脉瘤出血。SAH 组和非 SAH 组的新发动脉瘤均为小动脉瘤（<10mm）。预计 5 年内出血风险为 14.5%，高于 ISUIA（国际未破裂颅内动脉瘤研究）试验中小、未破裂动脉瘤的预期 SAH 风险。出血与以下任何危险因素之间均无统计学显著相关性：高血压、糖尿病、吸烟和饮酒、多囊肾病或既往 SAH。SAH 组患者年龄的组间差异具有统计学意义，SAH 组患者的平均年龄明显高于非 SAH 组（p=0.047）。这可能反映了更长的随访和发现时间，因为 SAH 组从初始治疗到发现新发动脉瘤的平均时间较长（p=0.011）。
虽然罕见，但新发动脉瘤可能有比同样大小的、最初发现的、未破裂的囊状动脉瘤更高的 SAH 风险。因此，作者建议对所有动脉瘤患者进行长期随访，并考虑对新发动脉瘤采取比偶然发现的初始动脉瘤更积极的治疗策略。
