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首页> 外文期刊>Neurosurgery >Stratification of outcome for surgically treated unruptured intracranial aneurysms.
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Stratification of outcome for surgically treated unruptured intracranial aneurysms.

机译：手术治疗的未破裂颅内动脉瘤的结果分层。

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OBJECT: The combination of low anticipated rupture rates for many unruptured aneurysms, better delineation of treatment risks, and the availability of alternative modalities of treatment have led to heightened scrutiny of the surgical management of unruptured intracranial aneurysms. Most reports to date have provided aggregate data concerning surgical treatment risks. This study was performed to better delineate risk estimates for the surgical treatment of patients with unruptured intracranial aneurysms according to a patient's risk profile with regard to age, aneurysm location, and aneurysm size. METHODS: We studied 493 patients who were treated with surgical clipping of 604 unruptured saccular aneurysms. Information regarding aneurysm size, location, patient age, and 6-month or greater outcome were gathered prospectively from 1992 to 1999. Multivariate analysis was performed to identify independent risk factors for outcome. On the basis of the model, risk stratification curves were generated. RESULTS: In our series, the mean patient age was 53 years, and the mean lesion size was 8.8 mm. Lesion locations included the internal carotid artery (n = 259, 43%), the middle cerebral artery (n = 174, 28%), the anterior cerebral artery (n = 99, 17%), and the vertebrobasilar artery (n = 67, 11%). Multivariate analysis revealed that aneurysm size (beta = 0.122, P < 0.001), patient age (beta = 0.0308, P < 0.05), and vertebrobasilar location (beta = 1.37, P = 0.0080) were independently associated with high risk of poor outcome or death. CONCLUSION: Small aneurysms in the anterior circulation in young patients carry a very low treatment risk (approximately 1%), and treatment in elderly individuals (ages 70 years and older) with large lesions (greater than 10 mm), carries a significant risk of poor outcome (5% in the anterior circulation, 15% in the posterior circulation). The nomograms generated by this study should be particularly useful in discussing with patients the risks and benefits of surgical treatment of unruptured aneurysms.
机译：目的：许多未破裂动脉瘤的预期破裂率低，更好地描述治疗风险以及其他治疗方式的可利用性，导致对未破裂颅内动脉瘤的外科治疗的检查越来越严格。迄今为止，大多数报告都提供了有关手术治疗风险的汇总数据。进行这项研究的目的是根据患者的年龄，动脉瘤位置和动脉瘤大小的风险特征，更好地划定颅内动脉瘤破裂患者的手术治疗风险估计。方法：我们研究了493例经手术切开的604例未破裂的囊状动脉瘤的患者。从1992年至1999年，前瞻性地收集了有关动脉瘤大小，位置，患者年龄以及6个月或更长时间的结局的信息。进行了多变量分析，以确定结局的独立危险因素。在该模型的基础上，生成了风险分层曲线。结果：在我们的系列中，平均患者年龄为53岁，平均病变大小为8.8毫米。病变部位包括颈内动脉（n = 259，43％），大脑中动脉（n = 174，28％），大脑前动脉（n = 99，17％）和椎基底动脉（n = 67） ，11％）。多变量分析显示，动脉瘤大小（β= 0.122，P <0.001），患者年龄（β= 0.0308，P <0.05）和椎基底动脉位置（β= 1.37，P = 0.0080）与不良预后或高风险的高风险独立相关。死亡。结论：年轻患者前循环中的小动脉瘤具有极低的治疗风险（约1％），而具有较大病变（大于10毫米）的老年患者（70岁及以上）的治疗风险很高。结果差（前循环中为5％，后循环中为15％）。这项研究产生的列线图在与患者讨论手术治疗未破裂动脉瘤的风险和益处时特别有用。

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