Tomasello F, D'Avella D, Salpietro F M, Longo M
Neurosurgical Clinic, University of Messina, Italy.
J Neurosurg Sci. 1998 Mar;42(1 Suppl 1):47-51.
Autopsy and angiographic studies indicate that cerebral aneurysms occur in an estimated 0.2% to 8.9% of the general population. Modern noninvasive imaging techniques now detect these lesions in ever increasing numbers, and neurosurgeons are faced with a difficult decision about whether to recommend surgical treatment of incidentally discovered asymptomatic unruptured aneurysms (AA). While in the past an expectant management was generally recommended for AA, elective surgery is now advocated because of the risk of bleeding of the untreated aneurysm and the low operative morbidity and mortality rates of modern microneurosurgery. We performed a meta-analysis of the literature on morbidity and mortality from elective surgery for AA to obtain a more generalizable estimate of operative risk than is currently available. Our meta-analysis contained 19 series consisting of 343 cases of elective surgery for AA. There was a total of 3 deaths for a combined mortality rate of 0.87%, and a total of 15 deficits for a combined morbidity rate of 4.3%. These results compare favorably with the 10.3% natural history cumulative risk of mortality for unruptured aneurysms. The authors' personal experience with AA management was also reviewed and a particularly significant illustrative case is briefly reported. We recommend treatment for all asymptomatic aneurysms incidentally discovered particularly if: a) the aneurysm size is greater than 5 mm and arterial hypertension is present; b) the patient is otherwise healthy; c) the estimated life expectancy is > or = 10 years.
尸检和血管造影研究表明，脑动脉瘤在普通人群中的发生率估计为0.2%至8.9%。现代非侵入性成像技术现在检测到的这些病变数量不断增加，神经外科医生面临着一个艰难的决定，即是否建议对偶然发现的无症状未破裂动脉瘤（AA）进行手术治疗。虽然过去通常建议对AA采取观察等待的处理方式，但由于未治疗动脉瘤的出血风险以及现代显微神经外科手术较低的手术发病率和死亡率，现在主张进行择期手术。我们对关于AA择期手术发病率和死亡率的文献进行了荟萃分析，以获得比目前更具普遍性的手术风险估计。我们的荟萃分析包含19个系列，共343例AA择期手术病例。总共有3例死亡，综合死亡率为0.87%，共有15例神经功能缺损，综合发病率为4.3%。这些结果与未破裂动脉瘤10.3%的自然史累积死亡风险相比更具优势。我们还回顾了作者个人对AA处理的经验，并简要报告了一个特别有代表性的病例。我们建议对所有偶然发现的无症状动脉瘤进行治疗，特别是在以下情况下：a）动脉瘤大小大于5毫米且存在动脉高血压；b）患者其他方面健康；c）预计预期寿命≥10年。
