Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제13권1호
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  • Pages.28-32
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  • 2011
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  • 2234-8565(pISSN)
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  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
권호 표지

The Proportion of Small Aneurysms in the Ruptured Cerebral Aneurysmal Cases : Is the Small Aneurysm Safe From Rupture?

  • Kang, Suk-Hyung (Department of Neurosurgery, Spine Center, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine) ;
  • Hwang, Sung-Nam (Department of Neurosurgery, Yong-San Hospital, Chung-Ang University College of Medicine) ;
  • Nam, Taek-Kyun (Department of Neurosurgery, Yong-San Hospital, Chung-Ang University College of Medicine) ;
  • Park, Seung-Won (Department of Neurosurgery, Yong-San Hospital, Chung-Ang University College of Medicine)
  • 발행 : 2011.03.30
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : This study investigated the proportion of small cerebral aneurysm (<5 mm) to help in the decision making concerning unruptured small aneurysms using the proportion of ruptured small aneurysms as a guide. Methods : The records of aneurysm patients treated in our hospital from January 2004 to December 2006 were retrospectively reviewed. Patients with ruptured aneurysms were divided into five groups according to their sizes (Group1 defined as tiny :< 3, Group2 defined as very small: 3-5, Group3 defined as small: 5-7, Group4 defined as medium: 7-10 and Group5 defined as large: > 10mm). The clinical and radiological findings of the ruptured aneurysms were also evaluated. Results : The mean age of the 244 enrolled patients was 54.6 years. The mean size of the rupture and the unruptured aneurysms was 6.8 mm. The proportions of aneurysm sizes were 7.8% (<3 mm), 30.7% (3-5 mm), 25.4% (5-7 mm), 19.3% (7-10 mm) and 16.8% (<10 mm). Conclusion : The proportion of small ruptured aneurysms (<5 mm) was appreciable; the proportion was not small just to observe. The proportion of very small ruptured aneurysms (3-5 mm) was significant in patients who required surgery or endovascular coiling. Although tiny aneurysms (<3 mm) may have a very low risk of rupture, they should be closely followed-up to preclude such a catastrophe.

키워드

참고문헌

  1. Berenstein A, Flamm ES, Kupersmith MJ. Unruptured intracranial aneurysms. N Engl J Med 340:1439-40; author reply 1432-41, 1999
  2. Brett A. Unruptured intracranial aneurysms. N Engl J Med 340:1441-2, 1999
  3. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med 355:928-39, 2006 https://doi.org/10.1056/NEJMra052760
  4. Caplan LR. Should intracranial aneurysms be treated before they rupture? N Engl J Med 339:1774-5, 1998 https://doi.org/10.1056/NEJM199812103392409
  5. Clarke G, Mendelow AD, Mitchell P. Predicting the risk of rupture of intracranial aneurysms based on anatomical location. Acta Neurochir (Wien) 147:259-63; discussion 263, 2005 https://doi.org/10.1007/s00701-004-0473-3
  6. Connolly ES, Jr., Mohr JP, Solomon RA. Unruptured intracranial aneurysms. N Engl J Med 340:1440-41; author reply 1441-42, 1999
  7. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: A systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365-72, 2007 https://doi.org/10.1136/jnnp.2007.117655
  8. Hijdra A, Brouwers PJ, Vermeulen M, Van Gijn J. Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:1156-61, 1990 https://doi.org/10.1161/01.STR.21.8.1156
  9. The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. N Engl J Med 339:1725-33, 1998 https://doi.org/10.1056/NEJM199812103392401
  10. Ishibashi T, Murayama Y, Urashima M, Saguchi T, Ebara M, Arakawa H, et al. Unruptured intracranial aneurysms: Incidence of rupture and risk factors. Stroke 40:313-16, 2009 https://doi.org/10.1161/STROKEAHA.108.521674
  11. Isobe N, Sato H, Murakami T, Kurokawa Y, Seyama G, Oki S. Evaluation of ruptured cerebral aneurysms under 5 mm in size on 3D-rotation angiography. No Shinkei Geka 36:775-80, 2008
  12. Jayaraman MV, Mayo-Smith WW, Tung GA, Haas RA, Rogg JM, Mehta NR, et al. Detection of intracranial aneurysms: Multi-detector row CT angiography compared with DSA. Radiology 230:510-8, 2004 https://doi.org/10.1148/radiol.2302021465
  13. Jeong YG, Jung YT, Kim MS, Eun CK, Jang SH. Size and location of ruptured intracranial aneurysms. J Korean Neurosurg Soc 45:11-5, 2009 https://doi.org/10.3340/jkns.2009.45.1.11
  14. Joo SW, Lee SI, Noh SJ, Jeong YG, Kim MS, Jeong YT. What is the significance of a large number of ruptured aneurysms smaller than 7 mm in diameter? J Korean Neurosurg Soc 45:85-9, 2009 https://doi.org/10.3340/jkns.2009.45.2.85
  15. Karamessini MT, Kagadis GC, Petsas T, Karnabatidis D, Konstantinou D, Sakellaropoulos GC, et al. CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings. Eur J Radiol 49:212-23, 2004 https://doi.org/10.1016/S0720-048X(03)00173-6
  16. Kassell NF, Torner JC. Size of intracranial aneurysms. Neurosurgery 12:291-7, 1983 https://doi.org/10.1227/00006123-198303000-00007
  17. Kim JE, Lim DJ, Hong CK, Joo SP, Yoon SM, Kim BT. Treatment of unruptured intracranial aneurysms in South Korea in 2006: A nationwide multicenter survey from the Korean Society of Cerebrovascular Surgery. J Korean Neurosurg Soc 47:112-8, 2010 https://doi.org/10.3340/jkns.2010.47.2.112
  18. Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms: The first annual J. Lawrence pool memorial research symposium-controversies in the management of cerebral aneurysms. Neurosurgery 62:183-93; discussion 184-93, 2008 https://doi.org/10.1227/01.NEU.0000311076.64109.2E
  19. Lai HP, Cheng KM, Yu SC, Au Yeung KM, Cheung YL, Chan CM, et al. Size, location, and multiplicity of ruptured intracranial aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage. Hong Kong Med J 15:262-6, 2009
  20. Lall RR, Eddleman CS, Bendok BR, Batjer HH. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors. Sifting through the sands of data. Neurosurg Focus 26:E2, 2009
  21. McCormick WF, Acosta-Rua GJ. The size of intracranial saccular aneurysms. An autopsy study. J Neurosurg 33:422-7, 1970 https://doi.org/10.3171/jns.1970.33.4.0422
  22. Mitchell P, Gholkar A, Vindlacheruvu RR, Mendelow AD. Unruptured intracranial aneurysms. Benign curiosity or ticking bomb? Lancet Neurol 3:85-92, 2004 https://doi.org/10.1016/S1474-4422(03)00661-6
  23. Morita A, Fujiwara S, Hashi K, Ohtsu H, Kirino T. Risk of rupture associated with intact cerebral aneurysms in the Japanese population. A systematic review of the literature from Japan. J Neurosurg 102:601-6, 2005 https://doi.org/10.3171/jns.2005.102.4.0601
  24. Ohashi Y, Horikoshi T, Sugita M, Yagishita T, Nukui H. Size of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol 61:239-45; discussion 237-45, 2004 https://doi.org/10.1016/S0090-3019(03)00427-0
  25. Raymond J, Meder JF, Molyneux AJ, Fox AJ, Johnston SC, Collet JP, et al. Unruptured intracranial aneurysms: The unreliability of clinical judgment, the necessity for evidence, and reasons to participate in a randomized trial. J Neuroradiol 33:211-9, 2006 https://doi.org/10.1016/S0150-9861(06)77266-2
  26. Song J, Mao Y, Song D, Leng B, Gu Y. Relationship between characteristic geometry and risk of rupture in cerebral saccular aneurysm. Zhonghua Yi Xue Za Zhi 24:732-5, 2009
  27. Sonobe M, Yamazaki T, Yonekura M, Kikuchi H. Small unruptured intracranial aneurysm verification study: Suave study, japan. Stroke: 41;1966-77, 2010
  28. Stieg PE, Friedlander R. Unruptured intracranial aneurysms. N Engl J Med 340:1441; author reply 1441-2, 1999
  29. Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: An updated meta-analysis. Stroke 38:1404-10, 2007 https://doi.org/10.1161/01.STR.0000260955.51401.cd
  30. Wiebers DO, Whisnant JP, Huston J, 3rd, Meissner I, Brown RD, Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103-10, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3