Characteristics of intracranial aneurysms associated with Moyamoya disease - A review of 111 cases
Characteristics of intracranial aneurysms associated with Moyamoya disease - A review of 111 cases
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DOI：
10.1007/bf01411057
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发表时间：
1996-01-01
影响因子：
2.4
通讯作者：
Kamada, K
中科院分区：
文献类型：
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作者：
Kawaguchi, S;Sakaki, T;Kamada, K
本文回顾分析了111例烟雾病相关动脉瘤患者的临床资料。研究对象包括我们的12个病例和99个其他有充分记录的病例。111例患者共131个动脉瘤。男48例，女63例。平均年龄40.3岁。临床表现为颅内出血99例(89%)，脑缺血9例(8%)，后3例(2%)未提及。Hunt和Kosnik分级为1级占8%，2级占23%，3级占31%，4级占35%，5级占3%。131个动脉瘤中，73个(56%)位于Willis环周围，24个(18%)位于基底节，29个(22%)位于侧支血管，5个(4%)位于其他血管。46%的病例是手术治疗，51%是保守治疗，3%是血管内治疗。手术方式：夹颈49%，动脉瘤切除18%，动脉瘤包裹术11%，动脉瘤涂层或电灼术7%，血管重建术11%。结果：格拉斯哥预后评分1分占30%，2分占22%，3分占11%，4分占1%，5分占25%。预后不良的主要原因是初始临床分级差和再出血。25个动脉瘤随访血管造影显示，基底节或侧支血管上的动脉瘤全部消失。我们建议对与烟雾病相关的动脉瘤进行手术干预，以防止破裂或再出血，特别是对Willis环周围的动脉瘤。然而，对于基底节或侧支血管上发现的动脉瘤，不推荐直接手术。
A retrospective analysis of 111 patients with aneurysms associated with Moyamoya disease is presented. The subjects comprised of our 12 cases and 99 other well-documented cases. These 111 cases had 131 aneurysms. There were 48 males and 63 females. The average age was 40.3 years. The clinical manifestations were intracranial haemorrhage in 99 cases (89%), and ischaemic events in 9 cases (8%), but no mention was made of these in the last three cases (2%). The Hunt and Kosnik grades were grade 1 in 8%, grade 2 in 23%, grade 3 in 31%; grade 4 in 35%, and grade 5 in 3%. Of the 131 aneurysms, 73 (56%) were found distributed around the circle of Willis, 24 (18%) in the basal ganglia, 29 (22%) on collateral vessels, and 5 (4%) on other vessels. Forty-six percent of the cases were treated surgically, 51% conservatively, and 3% by endovascular procedures. The surgical procedures for the aneurysms were; neck clipping in 49%, aneurysmectomy in 18%, wrapping of the aneurysm in 11%, coating or cautery of the aneurysm in 7%, and revascularization only in 11%. The outcomes were Glasgow Outcome Scale 1 in 30%, 2 in 22%, 3 in 11%, 4 in 1%, and 5 in 25%. The main reasons for the unfavourable outcome were initial poor clinical grade and rebleeding. Follow-up angiography of 25 aneurysms demonstrated that all aneurysms in the basal ganglia or on the collateral vessels disappeared. We recommend surgical intervention for aneurysms associated with Moyamoya disease to prevent rupture or rebleeding, especially for aneurysms around the circle of Willis. However, direct surgery is not recommended for aneurysms found in the basal ganglia or on the collateral vessels.