Yasui N, Magarisawa S, Suzuki A, Nishimura H, Okudera T, Abe T
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Japan.
Neurosurgery. 1996 Dec;39(6):1096-100; discussion 1100-1. doi: 10.1097/00006123-199612000-00004.
We conducted a retrospective analysis of the clinical features of angiographically diagnosed unruptured intracranial aneurysms that were treated conservatively and subsequently ruptured.
At our center, we reviewed the angiographic and clinical features of 25 patients with subarachnoid hemorrhage caused by previously unruptured aneurysms.
Eleven of the 25 patients died, including 1 patient who had undergone surgery. Ten patients had single aneurysms, and 15 had multiple aneurysms. Thus, multiple aneurysms were significantly more common than single aneurysms. The associated disease was cerebral infarction in 12 patients, previous subarachnoid hemorrhage from different aneurysm in 8 patients, intracerebral hemorrhage in 3 patients, and other conditions in 2 patients. Aneurysm size was able to be evaluated after rupture in 20 patients. At initial diagnosis, 16 aneurysms measured less than 5 mm in maximum diameter; the size of most aneurysms had increased by the time of rupture, although the aneurysm size remained less than 5 mm in five patients. No relationship was found between aneurysm rupture and patient age, aneurysm size at initial diagnosis, or time interval from diagnosis to rupture. The incidence of aneurysm rupture in patients with cerebrovascular disease, although higher than the incidence in patients with other underlying disease, was not significant.
We conclude that small unruptured intracranial aneurysms measuring less than 5 mm are susceptible to the risk of rupture, so that radical treatment or careful follow-up examination should be considered.
我们对经血管造影诊断为未破裂颅内动脉瘤且接受保守治疗后发生破裂的患者的临床特征进行了回顾性分析。
在我们中心，我们回顾了25例由先前未破裂动脉瘤引起蛛网膜下腔出血患者的血管造影和临床特征。
25例患者中有11例死亡，其中1例接受了手术。10例患者为单个动脉瘤，15例为多个动脉瘤。因此，多个动脉瘤比单个动脉瘤明显更常见。相关疾病为脑梗死12例，既往不同动脉瘤引起的蛛网膜下腔出血8例，脑出血3例，其他情况2例。20例患者破裂后可评估动脉瘤大小。初诊时，16个动脉瘤最大直径小于5mm；大多数动脉瘤在破裂时大小增加，尽管5例患者的动脉瘤大小仍小于5mm。未发现动脉瘤破裂与患者年龄、初诊时动脉瘤大小或从诊断到破裂的时间间隔之间存在关联。脑血管疾病患者的动脉瘤破裂发生率虽高于其他基础疾病患者，但差异无统计学意义。
我们得出结论，直径小于5mm的小型未破裂颅内动脉瘤易发生破裂风险，因此应考虑进行根治性治疗或仔细的随访检查。
