Management of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations.
Management of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations.
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DOI：
10.1212/con.0000000000000418
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发表时间：
2017-02-01
期刊：
影响因子：
--
通讯作者：
Lanzino, Giuseppe
中科院分区：
文献类型：
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作者：
Flemming, Kelly D;Lanzino, Giuseppe
综述的目的：由于脑成像的使用和可用性的增加，未破裂的颅内动脉瘤和血管畸形被更频繁地发现。对这些实体的管理需要了解哪些患者有出血的高风险，以及哪些治疗方案可用。本文综述了未破裂的颅内动脉瘤、动静脉畸形、海绵状畸形、发育性静脉畸形和毛细血管扩张症的流行病学、自然病史和治疗策略。研究结果：合并队列研究和荟萃分析提高了预测每种血管异常出血的能力。已经开发了分数和工具来帮助医生预测未破裂的颅内动脉瘤的出血风险。未破裂颅内动脉瘤血管内治疗技术的进步提高了治疗难治宽颈动脉瘤的能力。分期(人口、高血压、年龄、动脉瘤大小、另一动脉瘤早期蛛网膜下腔出血、动脉瘤部位)评分和未破裂的颅内动脉瘤治疗评分可能是预测自然病史和治疗建议的有用工具。动静脉畸形和海绵状畸形每年发生出血的总风险约为2%至4%。对于这两个实体，既往出血预示着未来的出血。此外，其他选定的患者和放射学因素也会影响出血风险。应该将未来出血的风险与治疗的风险进行比较。发育性静脉畸形和毛细血管扩张大多为良性病变，很少有症状。
PURPOSE OF REVIEW: Unruptured intracranial aneurysms and vascular malformations are detected more frequently because of the increased use and availability of brain imaging. Management of these entities requires knowledge of which patients are at high risk for hemorrhage and what treatment options are available. This article summarizes the epidemiology, natural history, and management strategies for unruptured intracranial aneurysms, arteriovenous malformations, cavernous malformations, developmental venous anomalies, and capillary telangiectasias.RECENT FINDINGS: Pooled cohort studies and meta-analyses have improved the ability to predict hemorrhage for each vascular abnormality. Scores and tools have been developed to aid the practitioner in predicting hemorrhage risk for unruptured intracranial aneurysms. Advances in endovascular techniques for unruptured intracranial aneurysms have improved the ability to treat difficult wide-necked aneurysms.SUMMARY: Unruptured intracranial aneurysms are a common incidental finding. The PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm) score and Unruptured Intracranial Aneurysm Treatment Score may be useful tools for predicting natural history and treatment recommendations. The overall risk of hemorrhage for both arteriovenous malformations and cavernous malformations is about 2% to 4% per year. With both of these entities, prior hemorrhage predicts future hemorrhage. In addition, other select patient and radiologic factors influence risk of hemorrhage. The risk of future hemorrhage should be compared to the risk of treatment. Developmental venous anomalies and capillary telangiectasias are largely benign entities and rarely symptomatic.