Fujita K, Yamashita H, Masumura M, Nishizaki T, Tamaki N, Matsumoto S
Department of Neurosurgery, Kobe University, School of Medicine, Japan.
No Shinkei Geka. 1988 Mar;16(3):225-31.
The outcome of a consecutive series of 28 patients with giant aneurysm who had been followed without surgery from one month to 12 years after the diagnosis was made, are presented with reviewing their radiological and clinical features. Symptoms and signs were directly or indirectly attributable to the intracranial mass effect and nine patients (32%) presented subarachnoid hemorrhage. Subarachnoid hemorrhage was frequently associated with intraventricular or intracerebral hemorrhage, a poor clinical grading at admission and a high mortality. Subarachnoid hemorrhage was most often recorded from the giant aneurysm at the supraclinoid portion of the internal carotid artery and the vertebro-basilar artery, but the rupture from the intracavernous giant aneurysm, completely thrombosed giant aneurysm and the fusiform type of giant aneurysm was rare. The mortality rate in 28 cases for the above follow up period was 46% (13 in 28 cases) and major morbidity occurred in 11% (3 in 28 cases). The above outcome of non operated giant aneurysm cases may justify the surgical management of the giant aneurysm, but as the intracavernous giant aneurysm and thrombosed giant aneurysm are relatively harmless, surgical indication should be carefully decided, especially in the older patients.
本文报告了连续28例巨大动脉瘤患者的随访结果，这些患者在确诊后未经手术治疗，随访时间为1个月至12年，并回顾了他们的影像学和临床特征。症状和体征直接或间接归因于颅内占位效应，9例患者（32%）出现蛛网膜下腔出血。蛛网膜下腔出血常与脑室内或脑内出血、入院时临床分级差及高死亡率相关。蛛网膜下腔出血最常发生于颈内动脉鞍上部分和椎基底动脉的巨大动脉瘤，但海绵窦内巨大动脉瘤、完全血栓形成的巨大动脉瘤和梭形巨大动脉瘤破裂少见。在上述随访期间，28例患者的死亡率为46%（28例中有13例），严重致残率为11%（28例中有3例）。上述未手术巨大动脉瘤病例的结果可能支持对巨大动脉瘤进行手术治疗，但由于海绵窦内巨大动脉瘤和血栓形成的巨大动脉瘤相对无害，应谨慎决定手术指征，尤其是老年患者。
