未破裂脳動脈瘤症例の治療と転帰

抄録

Treatment and outcome of 41 patients with unruptured cerebral aneurysms (11 males, 30 females, 23-74 years, 53 years on average) were evaluated. They were discovered in 24 patients with subarachnoid hemorrhage due to a rupture of the other aneurysm, in 13 patients with neurological deficits and in 4 patients with headache (screening of organic lesions). Surgery was not performed on 7 patients or patients with severe subarachnoid hemorrhage. Two of 4 patients with intradural aneurysms developed a subarachnoid hemorrhage and had a poor outcome, whereas all 3 patients with extradural aneurysms had a good outcome. Surgery was performed on 26 patients. Twenty patients with aneurysm of less than 15mm diameter underwent direct surgery and all had a good outcome. Four patients with aneurysm larger than 15mm diameter underwent direct surgery and 3 had a poor outcome, whereas 2 patients who underwent a trapping with a balloon had a good outcome. From these findings, it is concluded that direct surgery should be done for an unruptured cerebral aneurysm less than 15mm diameter, but an embolization should be chosen at first for larger aneurysm. Direct surgery, if it is performed, requires cautions and through preparations pre- and intra-operatively.