Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
Department of Neurology, Ochsner Louisiana State University Health Sciences Center, Shreveport.
Mayo Clin Proc. 2021 Jul;96(7):1970-2000. doi: 10.1016/j.mayocp.2021.01.005. Epub 2021 May 13.
Unruptured intracranial aneurysms (UIAs) are commonly acquired vascular lesions that form an outpouching of the arterial wall due to wall thinning. The prevalence of UIAs in the general population is 3.2%. In contrast, an intracranial aneurysm may be manifested after rupture with classic presentation of a thunderclap headache suggesting aneurysmal subarachnoid hemorrhage (SAH). Previous consensus suggests that although small intracranial aneurysms (<7 mm) are less susceptible to rupture, aneurysms larger than 7 mm should be treated on a case-by-case basis with consideration of additional risk factors of aneurysmal growth and rupture. However, this distinction is outdated. The PHASES score, which comprises data pooled from several prospective studies, provides precise estimates by considering not only the aneurysm size but also other variables, such as the aneurysm location. The International Study of Unruptured Intracranial Aneurysms is the largest observational study on the natural history of UIAs, providing the foundation to the current guidelines for the management of UIAs. Although SAH accounts for only 3% of all stroke subtypes, it is associated with considerable burden of morbidity and mortality. The initial management is focused on stabilizing the patient in the intensive care unit with close hemodynamic and serial neurologic monitoring with endovascular or open surgical aneurysm treatment to prevent rebleeding. Since the results of the International Subarachnoid Aneurysm Trial, treatment of aneurysmal SAH has shifted from surgical clipping to endovascular coiling, which demonstrated higher odds of survival free of disability at 1 year after SAH. Nonetheless, aneurysmal SAH remains a public health hazard and is associated with high rates of disability and death.
未破裂颅内动脉瘤（UIAs）是常见的获得性血管病变，由于血管壁变薄而形成动脉壁的外膨。UIAs 在普通人群中的患病率为 3.2%。相比之下，颅内动脉瘤可能在破裂后表现出来，其典型表现为霹雳头痛，提示为动脉瘤性蛛网膜下腔出血（SAH）。以前的共识认为，尽管小的颅内动脉瘤（<7mm）不太容易破裂，但大于 7mm 的动脉瘤应根据具体情况考虑到动脉瘤生长和破裂的其他危险因素进行治疗。然而，这种区分已经过时。PHASES 评分是从几个前瞻性研究中汇集的数据，通过考虑不仅是动脉瘤的大小，而且是动脉瘤的位置等其他变量，提供了更精确的估计。国际未破裂颅内动脉瘤研究是对 UIAs 自然史的最大观察性研究，为 UIAs 管理的现行指南提供了基础。尽管 SAH 仅占所有中风亚型的 3%，但它与相当大的发病率和死亡率负担有关。初始治疗的重点是在重症监护病房稳定患者，密切进行血流动力学和连续神经监测，并进行血管内或开放手术动脉瘤治疗，以防止再出血。自国际蛛网膜下腔动脉瘤试验以来，动脉瘤性 SAH 的治疗已从手术夹闭转向血管内线圈，这表明在 SAH 后 1 年无残疾生存的可能性更高。尽管如此，动脉瘤性 SAH 仍然是一个公共卫生危害，与高残疾率和死亡率有关。
