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Neurological Surgery No Shinkei Geka Volume 43, Issue 6 （June 2015）

Neurological Surgery 脳神経外科 43巻6号（2015年6月発行）

Japanese English

研究

経過観察中に破裂した未破裂脳動脈瘤症例に関する検討 Analysis of Rupture during Follow-up of Unruptured Aneurysm 小山新弥 ¹ , 井上瑞穂 ¹ , 内田浩喜 ¹ , 新妻邦泰 ¹ , 斉藤敦志 ¹ , 昆博之 ¹ , 佐々木達也 ¹ , 西嶌美知春 ¹ Shinya KOYAMA ¹ , Mizuho INOUE ¹ , Hiroki UCHIDA ¹ , Kuniyasu NIIZUMA ¹ , Atsushi SAITO ¹ , Hiroyuki KON ¹ , Tatsuya SASAKI ¹ , Michiharu NISHIJIMA ¹ ¹青森県立中央病院脳神経外科 ¹Department of Neurosurgery, Aomori Prefectural Central Hospital キーワード： unruptured cerebral aneurysm , risk factor , subarachnoid hemorrhage Keyword: unruptured cerebral aneurysm , risk factor , subarachnoid hemorrhage pp.523-529

発行日 2015年6月10日 Published Date 2015/6/10

DOI https://doi.org/10.11477/mf.1436203064

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　未破裂脳動脈瘤の自然歴・破裂率に関する大規模臨床試験は，International Study of Unruptured Intracranial Aneurysms（ISUIA）によって初めて1998年に報告され²⁾，わが国においてもsmall unruptured aneurysm verification study, Japan（SUAVe, 2010）や日本未破裂脳動脈瘤悉皆調査（UCAS Japan, 2012）が相次いで報告された^8,9)．それらによると，大きさの大きいもの，くも膜下出血の既往，部位としては前交通動脈（anterior communicating artery：Acom），内頚動脈後交通動脈分岐部（internal carotid-posterior communicating artery：ICPC），椎骨-脳底動脈（vertebro-basilar artery：VABA），不規則な瘤の形状，多発性などが破裂しやすい因子として報告された．また，SUAVe studyでは観察期間の短い時期に多くのイベントが起こっていると報告している¹⁴⁾．今回われわれは，当施設で経過観察中に破裂した未破裂脳動脈瘤の臨床的特徴を明らかにするために，破裂危険因子および観察期間に着目しretrospectiveに検討したので，文献的考察を交えて報告する．

　Object:To elucidate clinical aspects of ruptured aneurysms, we retrospectively investigated associations between risk factors and ruptured and unruptured cases during conservative management.

　Methods:Two hundred and twenty-nine patients with 291 unruptured cerebral aneurysms treated between 2000 and 2012 were analyzed. Mean duration of observation was 62 months（1183.4 person-years). We investigated the following six risk factors：history of subarachnoid hemorrhage;multiplicity;location of aneurysms;aneurysm size ≤5mm;bleb or irregular forms;and follow-up period ＜1 year.

　Results:Twenty-two aneurysms in 22 patients（19 women;86.4%）ruptured during this study. The annual rate of rupture was 1.86%. In ruptured cases, mean age was 66.7 years. According to univariate analysis, aneurysm size≥5mm（p＝0.000), bleb or irregular form（p＝0.006）and duration of observation＜1 year（p＝0.000）were significantly associated with aneurysmal rupture. In multivariate analysis of these factors, aneurysm size≥5mm（p＝0.0188;odds ratio（OR），3.4;95% confidence interval（CI), 1.2-9.7）and duration of observation＜1 year（p＝0.006;OR, 5.0;95% CI, 1.6-14.9）represented independent risk factors for aneurysm rupture.

　Conclusions:The results of this study were almost the same as those of the UCAS Japan study. In addition, duration of observation ＜1 year was a risk factor for aneurysm rupture. When we decide on surgical treatment after considering factors such as aneurysm size, form, and surgical risk, surgery should be performed as soon as possible.