Neurological Surgery 脳神経外科49巻1号

2021年01月発行

特集 脳動脈瘤—Q ＆ Aで学ぶ開頭術，血管内治療のコツと使い分け Ⅰ脳動脈瘤治療に必須な基礎知識

脳動脈瘤の自然歴とエビデンスを患者にどう説明すればよいか？

著者： 森田明夫¹

所属機関： ¹日本医科大学脳神経外科

ページ範囲：P.8 - P.14

Point
・未破裂脳動脈瘤は頻度の高い病態であり，患者は過大に不安になる傾向があるが，まず重要なことは生活習慣の改善である．
・破裂のリスクや予測スコア，各種臨床試験，施設の治療成績といったデータを患者に提示し，意見交換を行った上で治療すべきかを決定する．
・脳動脈瘤発見後の経過観察では，初回は比較的早めに一度画像評価をしておくとよい．

参考文献

1）Tominari S, et al；Unruptured Cerebral Aneurysm Study Japan Investigators：Prediction model for 3-year rupture risk of unruptured cerebral aneurysms in Japanese patients. Ann Neurol 77：1050-1059, 2015

2）Morita A, et al；UCAS Japan Investigators：The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366：2474-2482, 2012

3）Juvela S, Lehto H：Risk factors for all-cause death after diagnosis of unruptured intracranial aneurysms. Neurology 84：456-463, 2015

4）Pyysalo L, et al：Long-term excess mortality of patients with treated and untreated unruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 84：888-892, 2013

5）Vlak MH, et al：Independent risk factors for intracranial aneurysms and their joint effect：a case-control study. Stroke 44：984-987, 2013

6）King JT Jr, et al：A failure to communicate：patients with cerebral aneurysms and vascular neurosurgeons. J Neurol Neurosurg Psychiatry 76：550-554, 2005

7）Yoshimoto Y, Tanaka Y：Risk perception of unruptured intracranial aneurysms. Acta Neurochir（Wien）155：2029-2036, 2013

8）Nozaki K, et al：Examination of the effectiveness of DVD decision support tools for patients with unruptured cerebral aneurysms. Neurol Med Chir（Tokyo）47：531-536；discussion 536, 2007

9）Etminan N, Rinkel GJ：Unruptured intracranial aneurysms：development, rupture and preventive management. Nat Rev Neurol 13：126, 2017

10）Inoue T, et al：Annual rupture risk of growing unruptured cerebral aneurysms detected by magnetic resonance angiography. J Neurosurg 117：20-25, 2012

11）Sonobe M, et al：Small unruptured intracranial aneurysm verification study：SUAVe study, Japan. Stroke 41：1969-1977, 2010

12）Backes D, et al：ELAPSS score for prediction of risk of growth of unruptured intracranial aneurysms. Neurology 88：1600-1606, 2017

13）Wiebers DO, et al：Unruptured intracranial aneurysms：natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362：103-110, 203

14）Yoshimoto Y：Publication bias in neurosurgery：lessons from series of unruptured aneurysms. Acta Neurochir（Wien）145：45-48, 2003

15）Algra AM, et al：Procedural clinical complications, case-fatality risks, and risk factors in endovascular and neurosurgical treatment of unruptured intracranial aneurysms：a systematic review and meta-analysis. JAMA Neurol 76：282-293, 2019

16）Shigematsu T, et al；JR-NET Investigators：Endovascular therapy for asymptomatic unruptured intracranial aneurysms：JR-NET and JR-NET2 findings. Stroke 44：2735-2742, 2013

17）Ikawa F, et al：Treatment risk for elderly patients with unruptured cerebral aneurysm from a nationwide database in Japan. World Neurosurg 132：e89-e98, 2019

18）Report of Japan Neurosurgery Registry（2015-2017）. Neurol Med Chir（Tokyo）59（Spec）：si13-si81, 2019

19）Naggara ON, et al：Endovascular treatment of intracranial unruptured aneurysms：systematic review and meta-analysis of the literature on safety and efficacy. Radiology 256：887-897, 2010

20）Tsutsumi K, et al：Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms. Stroke 30：1181-1184, 1990

21）Etminan N, et al：Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population：a systematic review and meta-analysis. JAMA Neurol 76：588-597, 2019

22）Ikawa F, et al：A register-based SAH study in Japan：high incidence rate and recent decline trend based on lifestyle. J Neurosurg 2020：1-9［Epub ahead of print］doi：10.3171/2020.1.JNS192848