Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
Neurosurgery. 2018 Jun 1;82(6):864-869. doi: 10.1093/neuros/nyx307.
Multiple cerebral aneurysms are encountered in approximately 15% to 35% of patients harboring unruptured cerebral aneurysms. It would be of clinical value to determine which of them is most likely to rupture.
To characterize features of the ruptured aneurysm relative to other concomitant fellow aneurysms in patients with multiple cerebral aneurysms.
From a total of 5720 patients who were prospectively registered in the Unruptured Cerebral Aneurysm Study in Japan, a subgroup of patients with multiple cerebral aneurysms who developed subarachnoid hemorrhage was extracted for this post hoc analysis. Intrapatient comparisons of each aneurysm were carried out using aneurysm-specific factors such as size, location, and shape to identify predictors of rupture among the fellow aneurysms in a patient with multiple cerebral aneurysms.
Twenty-five patients with 62 aneurysms were identified from the total cohort of 5720 patients. With the distinctiveness in size, which means the aneurysm was the single largest among the multiple aneurysms, the ruptured aneurysm in each case was discriminated from the other coexisting aneurysms with a sensitivity of 0.76 and specificity of 0.86.
Our results suggest that the largest aneurysm is likely to rupture among coexisting aneurysms in a patient with multiple cerebral aneurysms.
在患有未破裂脑动脉瘤的患者中，约有 15%至 35%会出现多个脑动脉瘤。确定其中哪些最有可能破裂具有重要的临床价值。
描述多发性脑动脉瘤患者中破裂动脉瘤与其他同时存在的未破裂动脉瘤的特征。
从日本未破裂脑动脉瘤研究中前瞻性注册的 5720 例患者中，提取出发生蛛网膜下腔出血的多发性脑动脉瘤患者亚组进行此项事后分析。使用动脉瘤特有的因素（如大小、位置和形状）对每个动脉瘤进行患者内比较，以确定多发性脑动脉瘤患者中未破裂动脉瘤的破裂预测因子。
从 5720 例患者的总队列中确定了 25 例患者的 62 个动脉瘤。破裂动脉瘤的大小独特，即动脉瘤在多个动脉瘤中是最大的，每个病例的破裂动脉瘤与其他共存的动脉瘤具有 0.76 的敏感性和 0.86 的特异性。
我们的研究结果表明，在多发性脑动脉瘤患者中，最大的动脉瘤最有可能破裂。
