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DOI: 10.1055/s-2002-33972
© Johann Ambrosius Barth
Empfehlungen zum Management nichtrupturierter intrakranieller Aneurysmen
Recommendations for the management of unruptured intracranial aneurysmsPublication History
Publication Date:
11 September 2002 (online)
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Zusammenfassung:
Das optimale Management von Patienten mit nichtrupturierten intrakraniellen Aneurysmen wird kontrovers diskutiert. Durch die Veröffentlichung neuer Studien in den letzten Jahren ist eine erhebliche Unsicherheit über das optimale Management von Patienten mit nichtrupturierten Aneurysmen entstanden. Die Sektion Vaskuläre Neurochirurgie der Deutschen Gesellschaft für Neurochirurgie hat eine interdisziplinäre Arbeitsgruppe gebildet, die in Anlehnung an die American Heart Association (AHA) eine Zusammenfassung der existierenden Daten vornehmen und Empfehlungen aussprechen soll. Entsprechend den von der AHA benutzten Kriterien sind die existierenden Daten zum natürlichen Verlauf eines nichtrupturierten Aneurysmas einschließlich der aktuell publizierten Arbeiten hinsichtlich ihres Gewichtes lediglich dem Level IV-V zuzuordnen (historische Kohortenvergleiche oder retrospektive Fallserien). Damit unterstützt die Datenlage Vorschläge zum Management (“Grad C-Empfehlung” der AHA), aber keine Standards und keine Richtlinien. Die vorliegenden Empfehlungen sind im interdisziplinären neuromedizinischen Konsens entstanden und berücksichtigen die aktuellen Daten zum natürlichen Verlauf der nichtrupturierten Aneurysmen und die Risiken der einzelnen Behandlungsverfahren.
Summary
Optimal management of patients with unruptured intracranial aneurysms (UIAs) remains controversial. Recent studies have found conflicting data regarding the natural history and the treatment outcome of UIAs. Based on the recommendations published by the American Heart Association, the Section of Vascular Neurosurgery of the German Society of Neurosurgery has formed a task force to summarize the available data and to develop a practical framework for the management of UIAs. For UIAs, only evidence from nonrandomized historical cohort comparisons and case series without control subjects are available, supporting only grade C recommendations (options), but no standards (grade A) and no guidelines (grade B). The present recommendations have been developed as a neurosurgical, neuroradiological and neurological consensus. They are based on the existing data of both treatment risks and the risks of the natural history of UIAs.
Schlüsselwörter
Nichtrupturiertes Aneurysma - Aneurysma - Therapie
Key words:
Unruptured intracranial aneurysm - Natural history - Management - Outcome
Literatur
- 1 Hop J W, Rinkel G J, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997; 28 660-664
- 2 Bederson J B, Awad I A, Wiebers D O, Piepgras D, Haley E C, Brott T, Hademenos G, Chyatte D, Rosenwasser R, Caroselli C. Recommendations for the management of patients with unruptured intracranial aneurysms: A Statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 2000; 31 2742-2750
- 3 Whisnant J P, Sacco S E, O'Fallon W M, Fode N C, Sundt T M. Referral bias in aneurysmal subarachnoid hemorrhage. J.Neurosurg.. 1993; 78 726-732
- 4 Torner J C, Davis P H. Epidemiology and clinical manifestations of subarachnoid hemorrhage. Bederson, J. B. Subarachnoid hemorrhage: pathophysiology and management. Park Ridge, American Association of Neurological Surgeons. 1997: 1-26
- 5 Hop J W, Rinkel G J, Algra A, van Gijn J. Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage. Stroke. 1998; 29 798-804
- 6 Hutter B , Gilsbach J M. Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage?. Neurosurgery. 1993; 33 999-1005
- 7 Winn H R, Almaani W S, Berga S L, Jane J A, Richardson A E. The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J.Neurosurg.. 1983; 59 642-651
- 8 International Study of Unruptured Intracranial Aneurysms Investigators. . Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N. Engl. J. Med.. 1998; 339 1725-1733
- 9 Heiskanen O. Risk of bleeding from unruptured aneurysm in cases with multiple intracranial aneurysms. J. Neurosurg.. 1981; 55 524-526
- 10 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J. Neurosurg.. 2000; 93 379-387
- 11 Tsutsumi K, Ueki K, Morita A, Kirino T. Risk of rupture from incidental cerebral aneurysms. J. Neurosurg.. 2000; 93 550-553
- 12 Juvela S, Porras M, Heiskanen O. Natural history of unruptured intracranial aneurysms: a long-term follow-up study. J. Neurosurg.. 1993; 79 174-182
- 13 Graf C J. Prognosis for patients with nonsurgically-treated aneurysms. Analysis of the Cooperative Study of Intracranial Aneurysms and Subarachnoid hemorrhage. J. Neurosurg.. 1971; 35 438-443
- 14 Inagawa T, Hada H, Katoh H. Unruptured intracranial aneurysms in elderly patients. Surg. Neurol.. 1992; 38 364-370
- 15 Asari S, Ohmoto T. Natural history and risk factors of unruptured cerebral aneurysms. Clin. Neurol. Neurosurg.. 1993; 95 205-214
- 16 Yasui N, Suzuki A, Nishimura H, Suzuki K, Abe T. Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery. 1997; 40 1155-1159
- 17 Wiebers D O, Whisnant J P, Sundt T M, O'Fallon W M. The significance of unruptured intracranial saccular aneurysms. J. Neurosurg.. 1987; 66 23-29
- 18 Rinkel G J, Djibuti M, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998; 29 251-256
- 19 Yasui N, Magarisawa S, Suzuki A, Nishimura H, Okudera T, Abe T. Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery. 1996; 39 1096-1100
- 20 Mizoi K, Yoshimoto T, Nagamine Y, Kayama T, Koshu K. How to treat incidental cerebral aneurysms: a review of 139 consecutive cases. Surg. Neurol.. 1995; 44 114-120
- 21 Orz Y, Kobayashi S, Osawa M, Tanaka Y. Aneurysm size: a prognostic factor for rupture. Br. J. Neurosurg.. 1997; 11 144-149
- 22 Sampei T, Mizuno M, Nakajima S, Suzuki A, Hadeishi H, Ishikawa T, Yasui N. [Clinical study of growing up aneurysms: report of 25 cases]. No Shinkei Geka. 1991; 19 825-830
- 23 Hademenos G J, Massoud T F, Turjman F, Sayre J W. Anatomical and morphological factors correlating with rupture of intracranial aneurysms in patients referred for endovascular treatment. Neuroradiology. 1998; 40 755-760
- 24 Crompton M R. Mechanism of growth and rupture in cerebral berry aneurysms. Br. Med. J.. 1966; 5496 1138-1142
- 25 Allcock J M, Canham P B. Angiographic study of the growth of intracranial aneurysms. J. Neurosurg.. 1976; 45 617-621
- 26 Sarti C, Tuomilehto J, Salomaa V, Sivenius J, Kaarsalo E, Narva E V, Salmi K, Torppa J. Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985. Stroke. 1991; 22 848-853
- 27 Ronkainen A, Hernesniemi J, Puranen M, Niemitukia L, Vanninen R, Ryynanen M, Kuivaniemi H, Tromp G. Familial intracranial aneurysms. Lancet. 1997; 349 380-384
- 28 Raaymakers T W, Rinkel G J, Ramos L M. Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage. Neurology. 1998; 51 1125-1130
- 29 Schievink W I. Genetics of intracranial aneurysms. Neurosurgery. 1997; 40 651-662
- 30 The Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group. . Risks and benefits of screening for intracranial aneurysms in first- degree relatives of patients with sporadic subarachnoid hemorrhage. N. Engl. J. Med.. 1999; 341 1344-1350
- 31 David C A, Vishteh A G, Spetzler R F, Lemole M, Lawton M T, Partovi S. Late angiographic follow-up review of surgically treated aneurysms. J. Neurosurg.. 1999; 91 396-401
- 32 Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T. Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke. 2001; 32 1191-1194
- 33 Teunissen L L, Rinkel G J, Algra A, van Gijn J. Risk factors for subarachnoid hemorrhage: a systematic review. Stroke. 1996; 27 544-549
- 34 Ingall T J, Whisnant J P, Wiebers D O, O'Fallon M W. Has there been a decline in subarachnoid hemorrhage mortality?. Stroke. 1989; 20 718-724
- 35 Linn F H, Rinkel G J, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke. 1996; 27 625-629
- 36 Weir b. Unruptured intracranial aneurysms: a review. J. Neurosurg.. 2002; 96 3-42
- 37 Winn H R, Jane J A, Taylor J, Kaiser D, Britz G W. Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms. J. Neurosurg.. 2002; 96 43-49
- 38 Tsutsumi K, Ueki K, Usui M, Kwak S, Kirino T. Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms. Stroke. 1999; 30 1181-1184
- 39 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests. J. Neurosurg.. 1987; 66 30-34
- 40 Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology. 1999; 212 348-356
- 41 Uda K, Murayama Y, Gobin Y P, Duckwiler G R, Vinuela F. Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: clinical experience with 41 aneurysms in 39 patients. J. Neurosurg.. 2001; 95 624-632
- 42 Hayakawa M, Murayama Y, Duckwiler G R, Gobin Y P, Guglielmi G, Vinuela F. Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J. Neurosurg.. 2000; 93 561-568
- 43 Byrne J V, Sohn M J, Molyneux A J, Chir B. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J. Neurosurg.. 1999; 90 656-663
- 44 Kuether T A, Nesbit G M, Barnwell S L. Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience. Neurosurgery. 1998; 43 1016-1025
- 45 Raaymakers T W. Functional outcome and quality of life after angiography and operation for unruptured intracranial aneurysms. On behalf of the MARS Study Group. J. Neurol. Neurosurg. Psychiatry. 2000; 68 571-576
- 46 Raaymakers T W, Rinkel G J, Limburg M, Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke. 1998; 29 1531-1538
- 47 Brilstra E H, Rinkel G J, van der G Y, van Rooij W J, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke. 1999; 30 470-476
- 48 Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001; 32 1998-2004
- 49 Cloft H J, Joseph G J, Dion J E. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke. 1999; 30 317-320
PD Dr. Andreas Raabe
Neurochirurgische Klinik und Poliklinik
Schleusenweg 2-16
60528 Frankfurt am Main
Phone: 069 6301 5939
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