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首页> 外文期刊>Neurosurgical focus >Small (< 10-mm) incidentally found intracranial aneurysms, Part 2: Treatment recommendations, natural history, complications, and short-term outcome in 212 consecutive patients
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Small (< 10-mm) incidentally found intracranial aneurysms, Part 2: Treatment recommendations, natural history, complications, and short-term outcome in 212 consecutive patients

机译：偶然发现的颅内动脉瘤小（<10毫米），第2部分：212名连续患者的治疗建议，自然病史，并发症和短期结局

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Object: The management of incidental small unruptured intracranial aneurysms (UIAs) is controversial and many factors need to be considered in the decision-making process. The authors describe a large consecutive series of patients harboring small incidental intracranial aneurysms. Treatment strategy, natural history, complications, and short-term outcomes are presented. Methods: Between January 2008 and May 2011, the authors prospectively evaluated 212 patients with 272 small (< 10-mm) incidental aneurysms. Treatment recommendations (observation, endovascular treatment, or surgery), complications of treatment, and short-term outcomes were assessed. Results: Recommended treatment consisted of observation in 125 patients, endovascular embolization in 64, and surgery in 18. Six patients were excluded from further analysis because they underwent treatment elsewhere. In the observation group, at a mean follow-up of 16.7 months, only 1 patient was moved to the embolization group. Seven (6%) of the 125 patients in the observation group died of causes unrelated to aneurysm. Sixty-five patients underwent 69 embolization procedures. The periprocedural permanent morbidity and mortality rates in patients undergoing endovascular treatment were 1.5% and 1.5%, respectively (overall morbidity and mortality rate 3.0%). In the surgery group no periprocedural complications were observed, although 1 patient did not return to her previous occupation. No aneurysmal rupture was documented in any of the 3 treatment groups during the follow-up period. Conclusions: A cautious and individualized approach to incidental UIAs is of utmost importance for formulation of a safe and effective treatment algorithm. Invasive treatment (either endovascular or surgery) can be considered in selected younger patients, certain "higher-risk" locations, expanding aneurysms, patients with a family history of aneurysmal hemorrhage, and in those who cannot live their lives knowing that they harbor the UIA. Although the complication rate of invasive treatment is very low, it is not negligible. The study confirms that small incidental UIAs deemed to be not in need of treatment have a very benign short-term natural history, which makes observation a reasonable approach in selected patients.
机译：目的：偶然性小颅内破裂动脉瘤（UIA）的管理存在争议，在决策过程中需要考虑许多因素。这组作者描述了一系列连续的患者，这些患者都患有小偶然的颅内动脉瘤。介绍了治疗策略，自然病史，并发症和短期结果。方法：在2008年1月至2011年5月之间，作者前瞻性评估了212例272例小（<10毫米）附带性动脉瘤的患者。评估治疗建议（观察，血管内治疗或手术），治疗并发症和短期结果。结果：推荐的治疗包括观察125例，血管内栓塞64例，手术18例。有6例患者因为在其他地方接受了治疗而被排除在分析之外。在观察组中，平均随访16.7个月，只有1例患者被转移至栓塞组。观察组的125名患者中有七名（6％）死于与动脉瘤无关的原因。 65例患者接受了69次栓塞手术。接受血管内治疗的患者的围手术期永久发病率和死亡率分别为1.5％和1.5％（总发病率和死亡率为3.0％）。在外科手术组中，没有观察到围手术期并发症，尽管有1名患者未恢复其先前的职业。在随访期间，三个治疗组均未发现动脉瘤破裂。结论：谨慎且个性化的偶然UIAs方法对于制定安全有效的治疗算法至关重要。在某些较年轻的患者，某些“较高风险”的部位，动脉瘤扩大，有家族性动脉瘤出血病史的患者以及无法生存的患者中考虑采用侵入性治疗（血管内或手术） 。尽管侵入性治疗的并发症发生率很低，但它不可忽略。该研究证实，被认为不需要治疗的少量偶发UIA具有非常良性的短期自然病史，这使得观察对于某些患者而言是一种合理的方法。

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