脳動脈瘤治療の現状と今後の動向について

Abstract

Recently developed interventional radiologic techniques, such as embolization with platinum coils, may induce change of selection for cerebral aneurysmal therapy. The aim of the present study was to investigate current and future status of the treatment for cerebral aneurysms.We analyzed 159 cases with cerebral aneurysms by choice of treatment, surgery or interventional coil embolization. One hundred cases were ruptured, and 59 with 63 aneurysms were unruptured during the past 3 years. Fundamentally, the ruptured aneurysms were treated better than H & K grade IV.For patients who were older than 70 years, had a H & K grade IV, and/or were difficult to clip surgically, interventional coil embolization was selected. Thirteen cases with ruptured aneurysms were treated with embolization after subarachnoid hemorrhage, and one was embolized after failed surgical treatment. In the case of unruptured aneurysms, aneurysms with surgical difficulty, such as posterior circulation aneurysms or internal carotid (C2-3) aneurysms, coil embolization was selected. Among 63 unruptured aneurysms, 9 were treated with coil embolization.Fourteen percent of ruptured and unruptured aneurysms were treated with coil embolization. The factors by which treatment was decided, such as anesthesia, safety of technique, invasiveness of treatment, patient condition and longstanding effectiveness of each treatment, are important for future choices of treatment of aneurysms.