Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland.
Neurology Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland.
J Neurol Neurosurg Psychiatry. 2016 Dec;87(12):1277-1282. doi: 10.1136/jnnp-2016-313584. Epub 2016 Sep 30.
The management of small unruptured incidentally discovered intracranial aneurysms (SUIAs) is still controversial. The aim of this study is to assess the safety of a management protocol of SUIAs, where selected cases with SUIAs are observed and secured only if signs of instability (growth) are documented.
A prospective consecutive cohort of 292 patients (2006-2014) and 368 SUIAs (anterior circulation aneurysms (ACs) smaller than 7 mm and posterior circulation aneurysms smaller than 4 mm without previous subarachnoid haemorrhage) was observed (mean follow-up time of 3.2 years and 1177.6 aneurysm years). Factors associated with aneurysm growth were systematically reviewed from the literature.
The aneurysm growth probability was 2.6±0.1% per year. The rate of unexpected aneurysm rupture before treatment was 0.24% per year (95% CI 0.17% to 2.40%). The calculated rate of aneurysm rupture after growth was 6.3% per aneurysm-year (95% CI 1% to 22%). Aneurysms located in the posterior circulation and aneurysms with lobulation were more likely to grow. Females or patients suffering hypertension were more likely to have an aneurysm growing. The probability of aneurysms growth increased with the size of the dome and was proportional to the number of aneurysms diagnosed in a patient.
It is safe to observe patients diagnosed with SUIAs using periodic imaging. Intervention to secure the aneurysm should be performed after growth is observed.
小型未破裂偶然发现的颅内动脉瘤（SUIAs）的处理仍存在争议。本研究旨在评估一种 SUIAs 管理方案的安全性，该方案中，对选定的 SUIAs 患者仅进行观察和保护，如果有不稳定（生长）的迹象则进行记录。
前瞻性连续队列研究纳入了 292 例患者（2006-2014 年）和 368 个 SUIAs（前循环动脉瘤（ACs）小于 7mm，后循环动脉瘤小于 4mm，且无先前的蛛网膜下腔出血）。（平均随访时间为 3.2 年和 1177.6 个动脉瘤年）。从文献中系统地回顾了与动脉瘤生长相关的因素。
动脉瘤每年增长的概率为 2.6±0.1%。治疗前未预料到的动脉瘤破裂率为每年 0.24%（95%可信区间 0.17%至 2.40%）。计算得出的动脉瘤生长后破裂率为每年每 6.3%个动脉瘤（95%可信区间 1%至 22%）。位于后循环的动脉瘤和有分叶的动脉瘤更容易生长。女性或患有高血压的患者更容易发生动脉瘤生长。动脉瘤生长的概率随瘤顶的大小而增加，并与患者诊断出的动脉瘤数量成正比。
定期影像学检查可以安全地观察诊断为 SUIAs 的患者。在观察到生长后应进行干预以保护动脉瘤。
