Lee Gwang-Jin, Eom Ki-Seong, Lee Cheol, Kim Dae-Won, Kang Sung-Don
Department of Neurosurgery, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea.
Department of Anesthesiology, School of Medicine, Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2015 Sep;17(3):217-22. doi: 10.7461/jcen.2015.17.3.217. Epub 2015 Sep 30.
Unruptured intracranial aneurysms are now being detected with increasing frequency in clinical practice. Results of the largest studies, including those of the International Study of Unruptured Intracranial Aneurysms, indicate that surgical and endovascular treatments are rarely justified in small aneurysms. However, we have encountered several cases of rupture of small and very small aneurysms in our clinical practice. This retrospective study analyzed the incidence and clinical characteristics of very small ruptured aneurysms.
A total of 200 patients with aneurysmal subarachnoid hemorrhage between January 2012 and December 2014 were reviewed. Various factors were analyzed, including the aneurysm location and size as well as the associated risk factors.
The mean age of patients was 56.31 ± 13.78 (range, 25-89) years, and the male to female ratio was 1:2.1. There were 94 (47%) small-sized (< 5 mm), 91 (45.5%) medium-sized (5-9.9 mm), and 15 large-sized (> 10 mm) aneurysms. Of these, 30 (15%) aneurysms were very small-sized (< 3 mm). The most frequent site of aneurysms was the anterior communicating artery (ACoA). However, the proportion of aneurysms at the ACoA was significantly high in very small aneurysms (53.3%, p = 0.013). Hypertension was a significant risk factor for rupture of very small aneurysms (p < 0.001).
About half of our cases of ruptured aneurysms involved the rupture of small and very small aneurysms. The most common site of rupture of very small aneurysm was the ACoA. Rupture of small and very small aneurysms is unpredictable, and treatment may be considered in selected high-risk patients according to factors such as young age, ACoA location, and hypertension.
在临床实践中，未破裂颅内动脉瘤的检出频率日益增加。包括国际未破裂颅内动脉瘤研究在内的最大规模研究结果表明，对于小型动脉瘤，手术和血管内治疗很少有充分的理由。然而，我们在临床实践中遇到了几例小型和超小型动脉瘤破裂的病例。本回顾性研究分析了超小型破裂动脉瘤的发生率及临床特征。
回顾了2012年1月至2014年12月期间共200例动脉瘤性蛛网膜下腔出血患者。分析了各种因素，包括动脉瘤的位置、大小以及相关危险因素。
患者的平均年龄为56.31±13.78岁（范围25 - 89岁），男女比例为1:2.1。有94个（47%）小型（<5mm）、91个（45.5%）中型（5 - 9.9mm）和15个大型（>10mm）动脉瘤。其中，30个（15%）动脉瘤为超小型（<3mm）。动脉瘤最常见的部位是前交通动脉（ACoA）。然而，在超小型动脉瘤中，ACoA处动脉瘤的比例显著较高（53.3%，p = 0.013）。高血压是超小型动脉瘤破裂的一个显著危险因素（p < 0.001）。
我们的动脉瘤破裂病例中约一半涉及小型和超小型动脉瘤破裂。超小型动脉瘤最常见的破裂部位是ACoA。小型和超小型动脉瘤的破裂是不可预测的，对于选定的高危患者，可根据年龄、ACoA位置和高血压等因素考虑进行治疗。
