Khanna R K, Malik G M, Qureshi N
Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
J Neurosurg. 1996 Jan;84(1):49-54. doi: 10.3171/jns.1996.84.1.0049.
Surgical treatment of unruptured aneurysms is gaining increased support owing to the recently defined poor long-term natural history of these aneurysms. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk of surgery. To identify those patients at a higher risk from surgery, the authors reviewed the management of 172 patients with unruptured intracranial aneurysms treated at their institution. The size of the aneurysms ranged from 3 to 45 mm (mean 13.7 mm). Twenty-two patients (12.8%) had aneurysms in the posterior circulation, and 32 (18.6%) of these were giant aneurysms. Major morbidity occurred in 12 patients (6.9%) and five patients (2.9%) died. Multivariate logistic analysis of several risk factors revealed that aneurysm size and location had an independent correlation with surgical outcome and that patient age approached statistical significance. Patients presenting with ischemic cerebrovascular disease, in particular, did not have a higher risk of a poor outcome. A simple classification for predicting patients at high risk from surgical morbidity and mortality is proposed. Preoperative grading is based on the size and location of the aneurysm and patient's age. The lowest grade is given to young patients with small anterior circulation aneurysms, and the highest grade includes elderly patients with complex giant posterior circulation aneurysms. A retrospective analysis of this classification demonstrated a strong correlation with postoperative outcome. The incidence of poor outcome progressively increased with a higher grade, ranging from 0% in Grade 0 to 66.6% in Grade VI. An analysis of this classification on 50 consecutive surgically treated patients with unruptured aneurysms not included in the analysis also validated the predictive value of this system. Along with predicting outcome, this classification should provide a standardized format for comparison of results from different clinical centers as well as different therapeutic techniques (surgical vs. endovascular) without omission of significant risk factors found to influence outcome.
由于最近明确了未破裂动脉瘤不良的长期自然病史，未破裂动脉瘤的外科治疗得到了越来越多的支持。治疗的益处最终取决于未治疗患者后续动脉瘤破裂的相对风险与手术风险。为了识别那些手术风险较高的患者，作者回顾了在其机构接受治疗的172例未破裂颅内动脉瘤患者的治疗情况。动脉瘤大小从3毫米至45毫米不等（平均13.7毫米）。22例患者（12.8%）的动脉瘤位于后循环，其中32例（18.6%）为巨大动脉瘤。12例患者（6.9%）发生了严重并发症，5例患者（2.9%）死亡。对多个风险因素进行多变量逻辑分析显示，动脉瘤大小和位置与手术结果独立相关，患者年龄接近统计学显著性。特别是患有缺血性脑血管疾病的患者，其预后不良风险并不更高。提出了一种用于预测手术并发症和死亡率高风险患者的简单分类方法。术前分级基于动脉瘤的大小、位置和患者年龄。年轻且前循环小动脉瘤患者分级最低，而老年且后循环复杂巨大动脉瘤患者分级最高。对该分类方法的回顾性分析表明其与术后结果密切相关。随着分级升高，不良结果的发生率逐渐增加，从0级的0%到VI级的66.6%。对50例连续接受手术治疗但未纳入该分析的未破裂动脉瘤患者进行的该分类分析也验证了该系统的预测价值。除了预测结果外，该分类方法应提供一种标准化形式，用于比较不同临床中心以及不同治疗技术（手术与血管内治疗）的结果，且不会遗漏发现的影响结果的重要风险因素。
