Bleeding Risk in Unruptured and Residual Cerebral Aneurysms – Angiographic Annual Growth Rate in Nineteen Patients
Bleeding Risk in Unruptured and Residual Cerebral Aneurysms – Angiographic Annual Growth Rate in Nineteen Patients
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未破裂和残留脑动脉瘤的出血风险 – 19 名患者的血管造影年增长率
DOI：
10.1007/s007010050279
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发表时间：
1999
影响因子：
2.4
通讯作者：
T. Kubo
中科院分区：
文献类型：
--
作者：
H. Kamitani;Hideaki Masuzawa;I. Kanazawa;T. Kubo
未破裂的动脉瘤或不完全手术后的动脉瘤休息是否以及何时导致后续出血是神经外科医生关注的主要问题。通过计算长期随访血管造影（部分辅以核磁共振成像和/或核磁共振血管造影）中动脉瘤的年增长率，我们试图确定这些动脉瘤的手术指征。对5例未完全闭塞的破裂动脉瘤、6例术中已完全闭塞的多发动脉瘤、漏诊或误诊的小未破裂动脉瘤和8例无症状或有症状的未破裂动脉瘤进行了1 ~ 20年的长期随访血管造影。研究动脉瘤年生长速率与术后出血的相关性。6个快速生长且年增长率高的动脉瘤（年增长率超过8%）中有4个导致出血，而14个缓慢生长且年增长率低的动脉瘤（年增长率低于8%）中没有一个导致出血（Fisher精确检验；p<0.01）。高血压、患者年龄和动脉瘤位置与年增长率无显著相关性（Fisher精确检验；p < 0.05）。本研究提示，手术不完全后残存的动脉瘤及快速生长的多发或偶发动脉瘤的漏诊或误诊，后续出血的可能性较大，应尽早手术治疗。
Whether and when unruptured aneurysms or aneurysmal rests following incomplete surgery result in subsequent bleeding are major concerns for neurosurgeons. By calculating the annual growth rate of aneurysms in long-term follow-up angiography (partly supplemented with MR-imaging and/or MR-angiography), we attempted to determine the surgical indications for these aneurysms. Long-term follow-up angiography ranging from one to 20 years was carried out on five patients whose ruptured aneurysms had been incompletely occluded, six patients with multiple aneurysms, of which the ruptured ones had been completely oblitered at operation and the small unruptured aneurysms, missed or misdiagnosed, and eight patients with unruptured aneurysms which were asymptomatic or symptomatic. The correlation of annual aneurysm growth rate to subsequent bleeding was investigated. Four out of six fast-growing aneurysms with high annual growth rates (more than 8% increase per year) resulted in subsequent bleeding whereas none of the fourteen slow-growing aneurysms with low annual growth rates (less than 8% increase per year) led to bleeding (Fisher's exact test; p<0.01). Hypertension, patient age and aneurysmal location showed no significant correlation to the annual growth rate (Fisher's exact test; p>0.05). This study suggests that aneurysmal rests after incomplete surgery and missed or misdiagnosed multiple or incidental aneurysms which are fast growing have a high possibility of subsequent bleeding and should be operated on as soon as possible.