未破裂脳動脈瘤 クリッピング術の術前スコアリングよりみた未破裂脳動脈瘤の治療選択―高スコア症例の血管内手術または経過観察への振り分け―

Abstract

Complication of the surgical treatment for unruptured cerebral aneurysms is not ignorable especially for high-risk patients whose preoperative score is more than 2. The preoperative score consisted of aneurysm size (0: below 14 mm, 1: 15-24 mm, 2: over 25 mm), location (0: other location than posterior fossa and paraclinoid, 1: paraclinoid, 2: posterior fossa), multiplicity (0: treatable with single approach, 1: different approach necessary), and systemic diseases (0: no disease other than cerebral aneurysm, 1: one disease, 2: more than 2 diseases). Since 1997, we have conducted preoperative scoring and managed the unruptured cerebral aneurysms with scores of over 2 by observation, intravascular surgery or clipping surgery. Surgical results were evaluated using a modified Rankin scale (mRS). Before scoring, surgical complications exceeding mRS III occurred in 7.5% of cases, whereas this figure declined to 2.5% in the surgical results since 1997. When results of clipping surgery and intravascular surgery were compared, the former showed 3.8% and the latter showed 0% of complications exceeding mRS III. The results indicate that clipping surgery combined with intravascular surgery improves surgical outcome for unruptured cerebral aneurysms with high risk.