巨大動脈瘤に対する治療成績とその戦略

抄録

Introduction: To evaluate the clinical outcomes and factors affecting the prognosis of giant aneurysms and to better establish the role of microsurgery with bypass in its management.

Materials and Methods: Forty-eight patients with surgically treated giant aneurysms were included in this study. A giant aneurysm is defined as an aneurysm with a maximum diameter of ≥25 mm. Poor outcomes were defined as modified Rankin scale scores of 3-6.

Results: The mean size of the aneurysms was 30.9 mm (range, 25.0-54.9 mm). In 38 (79.2%) patients, the aneurysms were completely occluded without residual aneurysms, eight (16.7%) patients had minor aneurysm remnants, and two (4.2%) had incomplete occlusion. Two (1.3%) patients with giant basilar artery trunk aneurysms died due to rupture of the treated aneurysm. Bypass surgery was combined with microsurgery in 45 (93.8%) patients. Perforating artery infarction was observed postoperatively in 18 (37.5%) patients, and poor outcomes were observed in 12 (25.0%) patients. Male sex (p=0.002; odds ratio [OR]: 10.000, [2.262-44.203]), perforating artery infarction (p=0.036; OR: 5.200, [1.277-21.181]), branches arising from the aneurysms (p=0.031; OR: 4.900, [1.219-19.689]), and location of the aneurysm (p=0.002) were significantly associated with poor outcomes.

Conclusion: Microsurgery with bypass is an acceptable treatment modality for several giant aneurysms. Infarction of the perforating artery remains an unsolved problem, for which additional surgical strategies are required.