Khurana V G, Piepgras D G, Whisnant J P
Department of Neurologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Neurosurg. 1998 Mar;88(3):425-9. doi: 10.3171/jns.1998.88.3.0425.
The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms.
The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital.
Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.
本研究旨在评估破裂性巨大动脉瘤所致初次蛛网膜下腔出血（SAH）后再出血的频率及时间。
作者回顾了1973年至1996年间在梅奥诊所接受治疗的109例因巨大动脉瘤导致初次SAH的患者记录。他们占该机构在这23年期间所见巨大颅内动脉瘤患者的25%。其中7例患者来自明尼苏达州罗切斯特市，其余患者由其他机构转诊而来。动脉瘤直径在25至60毫米之间，74%位于颅内前循环动脉。入院14天后再出血的累积频率为18.4%。部分患者的再出血与脑脊液引流、脑血管造影及动脉瘤延迟复发有关。动脉瘤内血栓形成并不能预防再出血。在梅奥诊所发生复发性SAH的患者中，33%在医院死亡。
巨大动脉瘤再出血的发生率与较小动脉瘤相当，这一发现应在治疗策略中予以考虑。
