Guidelines for the surgical treatment of unruptured intracranial aneurysms: The first annual J. Lawrence Pool memorial research symposium - Controversies in the management of cerebralaneurysms
Guidelines for the surgical treatment of unruptured intracranial aneurysms: The first annual J. Lawrence Pool memorial research symposium - Controversies in the management of cerebralaneurysms
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DOI：
10.1227/01.neu.0000311076.64109.2e
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发表时间：
2008-01-01
期刊：
影响因子：
4.8
通讯作者：
Solomon, Robert A.
中科院分区：
文献类型：
--
作者：
Komotar, Ricardo J.;Mocco, J.;Solomon, Robert A.
未破裂脑动脉瘤的治疗仍然是神经外科领域最具争议的话题之一。为此，我们讨论了这些病变的诊断和估计患病率，并回顾了有关脑动脉瘤破裂率和手术干预风险的文献。我们对文献的解释得出结论，动脉瘤存在于大约1%的成年人群中，在年轻人中不到1%到老年人中4%之间变化。对于直径为7 - 10 mm的未破裂颅内动脉瘤，蛛网膜下腔出血的年风险约为1%。基于这些假设，我们建议：1）除极少数例外情况外，所有症状性未破裂动脉瘤均应接受治疗; 2）几乎所有病例中直径小于5 mm的小型偶发动脉瘤均应保守治疗; 3）年龄小于60岁的患者中大于5 mm的动脉瘤应认真考虑治疗; 4）几乎所有年龄小于70岁的患者都应治疗大于10 mm的大型偶发动脉瘤; 5）显微外科夹闭术而非血管内弹簧圈栓塞术应是低风险病例的首选治疗方法。我们的指南的关键是由一个经验丰富的脑血管团队的显微神经外科医生和血管内神经外科医生合作，在一个三级医疗中心工作，具有高病例量，并使用一个决策模式，旨在提供低风险的治疗。在某些患者的治疗和自然病史都具有高风险，如巨大动脉瘤，非手术治疗通常是选择。
THE MANAGEMENT OF unruptured cerebral aneurysms remains one of the most controversial topics in neurosurgery. To this end, we discuss the diagnosis and estimated prevalence of these lesions as well as review the literature regarding the rate of rupture for cerebral aneurysms and risks of operative intervention. Our interpretation of the literature concludes that aneurysms are present in approximately 1 % of the adult population, varying between less than 1 % in young adults to 4% in the elderly. The yearly risk of subarachnoid hemorrhage for an unruptured intracranial aneurysm is approximately 1% for lesions 7 to 10 mm in diameter. Based on these assumptions, we recommend that 1) with rare exceptions, all symptomatic unruptured aneurysms should be treated; 2) small, incidental aneurysms less than 5 mm in diameter should be managed conservatively in virtually all cases; 3) aneurysms larger than 5 mm in patients younger than 60 years of age should be seriously considered for treatment; 4) large, incidental aneurysms larger than 10 mm should be treated in nearly all patients younger than 70 years of age; and 5) microsurgical clipping rather than endovascular coiling should be the first treatment choice in low-risk cases. Critical to our guidelines is collaboration by a highly experienced cerebrovascular team of microneurosurgeons and endovascular neurosurgeons working at a tertiary medical center with a high case volume and using a decision-making paradigm designed to offer only low-risk treatments. In certain patients for whom both treatment and natural history carry high risks, such as those with giant aneurysms, nonoperative management is typically elected.