Kataoka Hiroharu
Department of Neurosurgery, National Cerebral and Cardiovascular Center.
No Shinkei Geka. 2024 Sep;52(5):1042-1049. doi: 10.11477/mf.1436205014.
Long-term follow-up results from the International Subarachnoid Aneurysm Trial suggest that coiling is preferable for ruptured aneurysms treatable with both modalities. This finding has led to a growing trend towards coiling for these patients. At our institute, coiling is now the first-line treatment for ruptured aneurysms, with exceptions for middle cerebral artery aneurysms. We also favor direct surgery for small ruptured aneurysms(<3 mm), cases with massive intracerebral hematoma, or situations requiring bypass surgery. While early rebleeding after coiling is uncommon, it carries a certain risk. Therefore, we sometimes choose clipping for ruptured anterior communicating artery or posterior communicating artery aneurysms if clipping poses minimal technical difficulty. To achieve optimal outcomes for ruptured aneurysms, a combined approach is crucial. This involves safe and effective endovascular treatment alongside necessary direct surgical interventions.
国际蛛网膜下腔动脉瘤试验的长期随访结果表明，对于两种治疗方式均可治疗的破裂动脉瘤，弹簧圈栓塞术更具优势。这一发现使得针对这些患者采用弹簧圈栓塞术的趋势日益增加。在我们研究所，目前弹簧圈栓塞术是破裂动脉瘤的一线治疗方法，但大脑中动脉动脉瘤除外。我们也倾向于对小型破裂动脉瘤（<3mm）、伴有大量脑内血肿的病例或需要进行搭桥手术的情况进行直接手术。虽然弹簧圈栓塞术后早期再出血并不常见，但仍存在一定风险。因此，如果夹闭术的技术难度最小，我们有时会选择对破裂的前交通动脉或后交通动脉动脉瘤进行夹闭。为了实现破裂动脉瘤的最佳治疗效果，联合治疗方法至关重要。这包括安全有效的血管内治疗以及必要的直接手术干预。
