Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms
Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms
复制标题
DOI：
10.3171/jns.2006.104.2.188
复制
发表时间：
2006-02-01
影响因子：
4.1
通讯作者：
Chang, HS
中科院分区：
文献类型：
--
作者：
Chang, HS
目的。尽管最近发表了大规模研究数据，但关于未破裂脑动脉瘤治疗的争议仍在继续。国际未破裂颅内动脉瘤研究 (ISUIA) 的低破裂率显然与外科医生处理破裂动脉瘤的经验相矛盾。在本研究中，基于 ISUIA 的数据，开发了描述脑动脉瘤自然史的数学模型。通过该模型，作者旨在检验ISUIA数据的有效性，并为未破裂动脉瘤提供更好的治疗指南。方法。作者对脑动脉瘤的自然史进行了计算机模拟，用于计算未破裂动脉瘤的患病率、蛛网膜下腔出血（SAH）的发生率以及未破裂和破裂动脉瘤的年龄和大小分布等数据。还计算了不同年龄和动脉瘤大小的个体患者的终生病变破裂概率，从而为患者的医疗决策过程提供了有用的指标。计算机模型生成了一般人群中未破裂动脉瘤的样本，其患病率为 4.2%，中位直径为 5.8 毫米。这些未破裂动脉瘤（受 ISUIA 报告的破裂率影响）的年 SAH 发病率为每 10 万人 19.6 例。这些动脉瘤的中位直径为 9.4 毫米。结论。本研究的结果验证了 ISUIA 的结果，表明看似较低的破裂率可以解释破裂动脉瘤的统计数据。利用该模型，作者计算了病变破裂的终生概率，这是决定未破裂动脉瘤最佳治疗方法的有用指标。
Object. Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons' experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms.Methods. The author made a computer simulation of the natural history of cerebral aneurysms that was used to calculate such figures as the prevalence of unruptured aneurysms, incidence of subarachnoid hemorrhage (SAH), and age and size distribution of both unruptured and ruptured aneurysms. The lifetime lesion rupture probability for individual patients with various ages and aneurysm sizes was also computed, thereby providing a useful index to help patients in the medical decision-making process.The computer model produced a sample of unruptured aneurysms in the general population with a prevalence of 4.2% and a median diameter of 5.8 mm. These unruptured aneurysms-affected by the rupture rate reported in the ISUIA-had a yearly SAH incidence of 19.6 per 100,000 persons. The median diameter of these aneurysms was 9.4 mm.Conclusions. Findings in the present study validated the results of the ISUIA by showing that the seemingly low rupture rates could explain the statistical data for ruptured aneurysms. With the featured model, the author calculated the lifetime probability of lesion rupture-a useful measure for deciding on the optimal treatment for unruptured aneurysms.