在未破裂的内动脉瘤中,从保守管理到干预管理
Benedikt Bandhauer1, Philipp Gruber2, Lukas Andereggen1,3
11Department of Neurosurgery, Cantonal Hospital Aarau, Switzerland.
Journal of neurosurgery
|September 27, 2024
概括
在未破裂的内动脉瘤 (UIA) 中,从保守治疗转变为侵入性治疗的可能性很低. 然而,超过3毫米的动脉瘤可能需要干预,强调需要密切监测.
科学领域:
- 神经外科 神经外科
- 放射学 放射学是一门学科.
- 血管神经学 血管神经学
背景情况:
- 未破裂的内动脉瘤 (UIAs) 的管理包括评估年龄,病史和动脉瘤特征等因素.
- 在随访期间,UIAs的初始非侵入性管理可能会被修改为外科手术或内血管干预.
- 确定UIA治疗策略变化的预测因素对于最佳的患者护理至关重要.
研究的目的:
- 识别UIA的特征模式和潜在预测因素,需要对最初的保守管理策略进行修订.
- 分析影响UIA从非侵入性转向侵入性治疗的决定的因素.
主要方法:
- 对2006年至2022年间诊断的内动脉瘤 (IA) 病例的回顾性审查,最初以保守的方式管理.
- 分析患者的人口统计,并发症,UIA血管架构,位置和诊断时的大小.
- 评估治疗策略的变化,包括原因,时间和干预方式.
主要成果:
- 在144例保守管理的IA病例中,10例 (6.9%) 在平均26个月的随访后需要干预 (剪切或栓塞).
- 干预的原因包括动脉瘤增长 (7例),配置变化 (2例),或两者 (1例).
- 在诊断时动脉瘤大小≥3毫米与改变治疗策略的风险增加有关;没有保守管理的UIA破裂.
结论:
- 对于最初保守地管理的UIA,转向侵入性治疗是不常见的.
- 动脉瘤生长和配置变化是修改治疗策略的主要驱动因素.
- 测量<3毫米的UIA不太可能需要干预,而不是3毫米以上的UIA,这强调了对UIA>3毫米的定期放射性随访的重要性.
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