Yasui T, Sakamoto H, Kishi H, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M, Nakajima H
Department of Neurosurgery, Osaka City General Hospital.
No Shinkei Geka. 1998 Aug;26(8):679-84.
Long-term natural history of unruptured cerebral aneurysms is not found frequently. Hence, the indications for surgery on unruptured asymptomatic cerebral aneurysms are still unclear. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk involved in surgery. Clinical features of fourteen elderly patients aged over 70 years with incidentally discovered unruptured aneurysms were analyzed. Two were male and 12 were female, with ages ranging from 70 to 82 years (mean: 74.5 years). Aneurysms were located in the anterior circulation in 13 patients and in the posterior circulation in 1 patient. One patient had multiple aneurysms, that is, bilateral middle cerebral aneurysms. The size of all these aneurysms was less than 10 mm. The indication for surgery was determined case by case. General information about the natural history of incidentally discovered aneurysms was given to the patients and their relatives. Informed consent was based on the fact that subarachnoid hemorrhage was associated with a poor prognosis, while excellent operative results were common in patients with unruptured aneurysms. Five patients agreed to surgical treatment. Four of them, their ages being 70, 70, 72 and 72 years old, with aneurysms located on the middle cerebral arteries, underwent neck clipping of their aneurysms with no operative morbidity or mortality. However, the remaining one patient was not recommended for surgery in spite of her consent to having it, because of her high age (82 years) and the location of her aneurysm (intracavernous internal carotid artery). Consequently, 10 patients who didn't receive surgery were followed-up at periods ranging from 3 months to 7 years. Two patients developed rupture of the aneurysms, either proven (one patient) or presumed (one patient). The former patient made an uneventful recovery after surgery, but the latter died. None of the remaining eight patients have experienced rupture of the aneurysms. It is our clinical impression, however, that they harbor an unruptured aneurysm with at least mild trepidation. With the rapid aging of the population, withholding aneurysm surgery merely because a patient is elderly may not necessarily be the most appropriate decision. Our conclusions are as follows: (1) Elderly patients in their early seventies are apt to agree to having surgical treatment for their unruptured aneurysms. (2) The cases reported herein show that asymptomatic middle cerebral artery aneurysms were able to be clipped very safely. (3) Most patients have experienced a decrease in quality of life from knowing they are living with an unruptured aneurysm.
未破裂脑动脉瘤的长期自然病史并不常见。因此，未破裂无症状脑动脉瘤的手术指征仍不明确。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所涉及的风险。分析了14例70岁以上偶然发现未破裂动脉瘤的老年患者的临床特征。其中男性2例，女性12例，年龄70至82岁（平均74.5岁）。13例患者的动脉瘤位于前循环，1例位于后循环。1例患者有多发动脉瘤，即双侧大脑中动脉瘤。所有这些动脉瘤的大小均小于10毫米。手术指征逐例确定。向患者及其亲属提供了有关偶然发现动脉瘤自然病史的一般信息。知情同意的依据是蛛网膜下腔出血预后不良，而未破裂动脉瘤患者手术效果通常良好。5例患者同意手术治疗。其中4例，年龄分别为70、70、72和72岁，动脉瘤位于大脑中动脉，接受了动脉瘤夹闭术，无手术并发症和死亡。然而，其余1例患者尽管同意手术，但由于年龄较大（82岁）且动脉瘤位于海绵窦段颈内动脉，未被建议手术。因此，10例未接受手术的患者进行了3个月至7年的随访。2例患者发生动脉瘤破裂，1例经证实，1例为推测。前者术后恢复顺利，但后者死亡。其余8例患者均未发生动脉瘤破裂。然而，我们的临床印象是，他们至少仍有轻度恐惧地患有未破裂动脉瘤。随着人口的快速老龄化，仅仅因为患者年龄大就不进行动脉瘤手术不一定是最合适的决定。我们的结论如下：（1）70岁出头的老年患者倾向于同意对其未破裂动脉瘤进行手术治疗。（2）本文报道的病例表明，无症状大脑中动脉动脉瘤能够非常安全地夹闭。（3）大多数患者因知道自己患有未破裂动脉瘤而生活质量下降。
