A retrospective analysis on the natural history of incidental small paraclinoid unruptured aneurysm
A retrospective analysis on the natural history of incidental small paraclinoid unruptured aneurysm
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DOI：
10.1136/jnnp-2013-305019
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发表时间：
2014-03-01
影响因子：
11
通讯作者：
Kim, Jeong Eun
中科院分区：
文献类型：
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作者：
Jeon, Jin Sue;Ahn, Jun Hyong;Kim, Jeong Eun
目的对于偶发性床突旁未破裂颅内小动脉瘤（UIA）的最佳治疗方法仍存在争议。本回顾性研究的目的是揭示自然史的小床突旁UIAs的目标，通知治疗plannes.Methods 524例窝藏568床突旁UIAs（5毫米）的平均随访35.4个月期间进行了回顾性评价。根据动脉分支将动脉瘤分为两组：相关（眼动脉和上级垂体动脉）和非相关。审查了关于多个变量的医疗记录，如性别、年龄、高血压（HTN）、糖尿病、吸烟和动脉瘤因素（大小、动脉关系、多重性以及破裂和生长的发生率）。结果随访1675.5个月，2例囊肿破裂（0.35%），17例囊肿生长（3.0%），年破裂率为0.12%，年生长率为1.01%。无瘤样生长的累积生存率在4 mm（p=0.001）、HTN（p=0.002）和动脉分支相关位置（p=0.001）的动脉瘤中达到显著差异。多变量分析显示，动脉瘤4 mm（HR，4.41; p=0.003），HTN（HR，5.74; p=0.003），动脉分支相关位置（HR，6.04; p=0.002）和多重性（HR，0.27; p=0.042）的平均值结论虽然偶发性床突旁小UIA的破裂和生长相对较低，风险，具有高风险因素的患者，包括动脉瘤4 mm、HTN、动脉分支相关动脉瘤和多发动脉瘤，必须密切监测。应考虑本研究回顾性的局限性。
Objective The optimal consensus concerning treatment of incidental small paraclinoid unruptured intracranial aneurysms (UIAs) remains controversial. The aim of this retrospective study was to reveal the natural history of small paraclinoid UIAs with the goal of informing the treatment plan.Methods 524 patients harbouring 568 paraclinoid UIAs (5mm) were retrospectively evaluated during the mean follow-up of 35.4months. The aneurysms were divided into two groups with respect to arterial branch: related (ophthalmic and superior hypophyseal artery), and non-related. Medical records were reviewed concerning multiple variables, such as sex, age, hypertension (HTN), diabetes mellitus, smoking and aneurysmal factors (size, arterial relationship, multiplicity and the occurrence of rupture and growth). The cumulative risk and the risk factors of aneurysmal rupture and growth were analysed.Results Two aneurysmal (0.35%) ruptures and 17 growths (3.0%) were observed during the follow-up of 1675.5 aneurysm-years with an annual rupture of 0.12% and an annual growth of 1.01%. The cumulative survival without aneurysmal growth reached a significant difference in aneurysms 4mm (p=0.001), HTN (p=0.002), and arterial branch-related location (p=0.001). Multivariate analysis disclosed that aneurysm 4mm (HR, 4.41; p=0.003), HTN (HR, 5.74; p=0.003), arterial branch-related location (HR, 6.04; p=0.002), and multiplicity (HR, 0.27; p=0.042) were significant predictive factors for aneurysm growth.Conclusions Although incidental small paraclinoid UIAs have a relatively lower rupture and growth risk, patients with high-risk factors, including aneurysm 4mm, HTN, arterial branch-related aneurysms, and multiple aneurysms must be monitored closely. The limitation of the retrospective nature of this study should be taken into consideration.