未破裂脳動脈瘤の自然経過 : SUAVe Studyを含めて(<特集>脳動脈瘤に対する新たな考え方)
Small Unruptured Intracranial Aneurysm Verification Study (SUAVe Study, Japan)は小型未破裂脳動脈瘤の自然歴に関する研究であり,径5mm未満の未破裂脳動脈瘤の破裂率,増大率とそれぞれにかかわる危険因子を前方視的に検討した.2000年9月〜2004年1月までの3年4ヵ月間に540動脈瘤(446症例)が登録され,448動脈瘤(374症例)が平均42.5ヵ月間(1,306.2人・年,1,553.5動脈瘤・年)のfollow-up期間で経過観察された.観察期間中7症例(1.9%)にくも膜下出血を生じ,年間の破裂率は0.54%(...
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| Published in | 脳神経外科ジャーナル Vol. 21; no. 4; pp. 288 - 297 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
2012
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| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.21.288 |
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| Abstract | Small Unruptured Intracranial Aneurysm Verification Study (SUAVe Study, Japan)は小型未破裂脳動脈瘤の自然歴に関する研究であり,径5mm未満の未破裂脳動脈瘤の破裂率,増大率とそれぞれにかかわる危険因子を前方視的に検討した.2000年9月〜2004年1月までの3年4ヵ月間に540動脈瘤(446症例)が登録され,448動脈瘤(374症例)が平均42.5ヵ月間(1,306.2人・年,1,553.5動脈瘤・年)のfollow-up期間で経過観察された.観察期間中7症例(1.9%)にくも膜下出血を生じ,年間の破裂率は0.54%(単発症例0.34%,多発症例0.95%)であった.破裂にかかわる危険因子は年齢50歳未満,動脈瘤径4.0mm以上,高血圧,多発瘤であった.25症例(6.7%)に動脈瘤の増大を認め,その危険因子は動脈瘤径4.0mm以上,女性,多発瘤,喫煙であった.小型未破裂脳動脈瘤の破裂率は非常に低く,安定した動脈瘤と考えられる.しかし,上記リスクを抱える症例は,将来的に動脈瘤の破裂や増大にかかわる可能性を秘めており,注意深い観察や破裂予防処置を考慮する必要がある. |
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| AbstractList | Small Unruptured Intracranial Aneurysm Verification Study (SUAVe Study, Japan)は小型未破裂脳動脈瘤の自然歴に関する研究であり,径5mm未満の未破裂脳動脈瘤の破裂率,増大率とそれぞれにかかわる危険因子を前方視的に検討した.2000年9月〜2004年1月までの3年4ヵ月間に540動脈瘤(446症例)が登録され,448動脈瘤(374症例)が平均42.5ヵ月間(1,306.2人・年,1,553.5動脈瘤・年)のfollow-up期間で経過観察された.観察期間中7症例(1.9%)にくも膜下出血を生じ,年間の破裂率は0.54%(単発症例0.34%,多発症例0.95%)であった.破裂にかかわる危険因子は年齢50歳未満,動脈瘤径4.0mm以上,高血圧,多発瘤であった.25症例(6.7%)に動脈瘤の増大を認め,その危険因子は動脈瘤径4.0mm以上,女性,多発瘤,喫煙であった.小型未破裂脳動脈瘤の破裂率は非常に低く,安定した動脈瘤と考えられる.しかし,上記リスクを抱える症例は,将来的に動脈瘤の破裂や増大にかかわる可能性を秘めており,注意深い観察や破裂予防処置を考慮する必要がある. |
| Author | SUAVe, STUDY Japanグループ 菊池, 晴彦 米倉, 正大 山崎, 友郷 園部, 眞 |
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| References | 2) CROMPTON MR. Mechanism of growth and rupture in cerebral berry aneurysms. Brit Med J. (1966) vol.1, p.1138-1142. 24) The International Study of Unruptured Intracranial Aneurysms Investigators . Unruptured intracranial aneurysms : natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. (2003) vol. 362, p. 103 - 110 . doi:10.1016/S0140-6736(03)13860-3 4) International study of unruptured intracranial aneurysms investigators . Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N Engl J Med. (1998) vol. 339, p. 1725 - 1733 . 7) KASSELL NF. Sizes of intracranial aneurysms. Neurosurgery. (1983) vol.12, p.291-297. 21) YONEKURA M. Importance of prospective studies for deciding on a therapeutic guideline for unruptured cerebral aneurysm. Acta Neurochir [Supple]. (2002) vol.82, p.21-25. 22) 米倉, 正大. ほか. 未破裂脳動脈瘤の治療指針 : 小未破裂脳動脈瘤の手術適応(<特集>脳血管障害におけるEBM). 脳神経外科ジャーナル. 日本脳神経外科コングレス. (2008) vol.17, no.11, p.843-849. http://search.jamas.or.jp/link/ui/2009022997 25) YASUI N. Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery. (1997) vol.40, p.1155-1160. doi:10.1097/00006123-199706000-00007 18) SUZUKI J. Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg. (1978) vol.48, p.505-514. 5) ISHIBASHI T. Unruptured intracranial aneurysms : incidence of rupture and risk factors. Stroke. (2009) vol.40, p.313-316. 3) INAGAWA T. Size of ruptured intracranial saccular aneurysms in patients in Izumo City, Japan. World Neurosurg. (2010) vol.73, p.84-92. 15) OHASHI Y. Sizes of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol. (2004) vol.61, p.239-245. 10) MITCHELL P. Estimate of the maximum time interval between formation of cerebral aneurysm and rupture. J Neurol Neurosurg Psychiat. (2000) vol.69, p.760-767. 13) MORITA A. Management outcomes in the unruptured cerebral aneurysm study II (UCAS II) : Interim report-Quest for standards and current status in Japan. Jpn J Neurosurg (Tokyo). (2011) vol.20, p.484-490. 23) 森田 明夫. ほか. オンライン登録による未破裂脳動脈瘤アウトカム研究. 臨床神経学. 日本神経学会. (2002) vol.42, no.11, p.1188-1190. http://search.jamas.or.jp/link/ui/2003259645 9) MATSUBARA S. Incidence and risk factors for the growth of unruptured cerebral aneurysms : observation using serial computerized tomography angiography. J Neurosurg. (2004) vol.101, p.908-914. 1) BURNS JD. Intracranial aneurysm enlargement on serial magnetic resonance angiography : frequency and risk factor. Stroke. (2009) vol.40, p.406-411. 20) WIEBERS DO. The significance of unruptured intracranial saccular aneurysms. J Neurosurg. (1987) vol.66, p.23-29. 6) JUVELA S. Natural history of unruptured intracranial aneurysms : probability of and risk factors for aneurysm rupture. J Neurosurg. (2000) vol.93, p.379-387. 16) RAHMAN M. Unruptured cerebral aneurysms do not shrink when they rupture : Multicenter Collaborative Aneurysm Study Group. Neurosurgery. (2011) vol.68, p.155-161. 14) NAHED BV. Hypertension, age and location predict rupture of small intracranial aneurysms. Neurosurgery. (2005) vol.57, p.676-683. 11) MIYAZAWA N. Risk factors for growth of unruptured intracranial aneurysms : Follow-up study by serial 0.5-T magnetic resonance angiography. Neurosurgery. (2006) vol.58, p.1047-1053. 26) YOSHIMOTO T. Importance of unruptured cerebral aneurysms. Surg Neurol. (1997) vol.47, p.522-526. doi:10.1016/S0090-3019(96)00400-4 8) KATAOKA K. Structural fragility and inflammatory response of ruptured cerebral aneurysms. A comparative study between ruptured and unruptured cerebral aneurysms. Stroke. (1999) vol.30, p.1396-1401. 17) SONOBE M. Small unruptured intracranial aneurysm verification study : SUAVe Study, Japan. Stroke. (2010) vol.41, p.1969-1977. 12) MORITA A. Risk of rupture associated with intact cerebral aneurysms in the Japanese population : a systematic review of the literature from Japan. J Neurosurg. (2005) vol.102, p.601-606. 19) WERMER MJH. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics. An updated meta-analysis. Stroke. (2007) vol.38, p.1404-1410. |
| References_xml | – reference: 3) INAGAWA T. Size of ruptured intracranial saccular aneurysms in patients in Izumo City, Japan. World Neurosurg. (2010) vol.73, p.84-92. – reference: 26) YOSHIMOTO T. Importance of unruptured cerebral aneurysms. Surg Neurol. (1997) vol.47, p.522-526. doi:10.1016/S0090-3019(96)00400-4 – reference: 6) JUVELA S. Natural history of unruptured intracranial aneurysms : probability of and risk factors for aneurysm rupture. J Neurosurg. (2000) vol.93, p.379-387. – reference: 17) SONOBE M. Small unruptured intracranial aneurysm verification study : SUAVe Study, Japan. Stroke. (2010) vol.41, p.1969-1977. – reference: 13) MORITA A. Management outcomes in the unruptured cerebral aneurysm study II (UCAS II) : Interim report-Quest for standards and current status in Japan. Jpn J Neurosurg (Tokyo). (2011) vol.20, p.484-490. – reference: 1) BURNS JD. Intracranial aneurysm enlargement on serial magnetic resonance angiography : frequency and risk factor. Stroke. (2009) vol.40, p.406-411. – reference: 14) NAHED BV. Hypertension, age and location predict rupture of small intracranial aneurysms. Neurosurgery. (2005) vol.57, p.676-683. – reference: 24) The International Study of Unruptured Intracranial Aneurysms Investigators . Unruptured intracranial aneurysms : natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. (2003) vol. 362, p. 103 - 110 . doi:10.1016/S0140-6736(03)13860-3 – reference: 18) SUZUKI J. Clinicopathological study of cerebral aneurysms. Origin, rupture, repair, and growth. J Neurosurg. (1978) vol.48, p.505-514. – reference: 21) YONEKURA M. Importance of prospective studies for deciding on a therapeutic guideline for unruptured cerebral aneurysm. Acta Neurochir [Supple]. (2002) vol.82, p.21-25. – reference: 8) KATAOKA K. Structural fragility and inflammatory response of ruptured cerebral aneurysms. A comparative study between ruptured and unruptured cerebral aneurysms. Stroke. (1999) vol.30, p.1396-1401. – reference: 25) YASUI N. Long-term follow-up study of unruptured intracranial aneurysms. Neurosurgery. (1997) vol.40, p.1155-1160. doi:10.1097/00006123-199706000-00007 – reference: 20) WIEBERS DO. The significance of unruptured intracranial saccular aneurysms. J Neurosurg. (1987) vol.66, p.23-29. – reference: 23) 森田 明夫. ほか. オンライン登録による未破裂脳動脈瘤アウトカム研究. 臨床神経学. 日本神経学会. (2002) vol.42, no.11, p.1188-1190. http://search.jamas.or.jp/link/ui/2003259645 – reference: 11) MIYAZAWA N. Risk factors for growth of unruptured intracranial aneurysms : Follow-up study by serial 0.5-T magnetic resonance angiography. Neurosurgery. (2006) vol.58, p.1047-1053. – reference: 16) RAHMAN M. Unruptured cerebral aneurysms do not shrink when they rupture : Multicenter Collaborative Aneurysm Study Group. Neurosurgery. (2011) vol.68, p.155-161. – reference: 7) KASSELL NF. Sizes of intracranial aneurysms. Neurosurgery. (1983) vol.12, p.291-297. – reference: 9) MATSUBARA S. Incidence and risk factors for the growth of unruptured cerebral aneurysms : observation using serial computerized tomography angiography. J Neurosurg. (2004) vol.101, p.908-914. – reference: 5) ISHIBASHI T. Unruptured intracranial aneurysms : incidence of rupture and risk factors. Stroke. (2009) vol.40, p.313-316. – reference: 2) CROMPTON MR. Mechanism of growth and rupture in cerebral berry aneurysms. Brit Med J. (1966) vol.1, p.1138-1142. – reference: 10) MITCHELL P. Estimate of the maximum time interval between formation of cerebral aneurysm and rupture. J Neurol Neurosurg Psychiat. (2000) vol.69, p.760-767. – reference: 4) International study of unruptured intracranial aneurysms investigators . Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N Engl J Med. (1998) vol. 339, p. 1725 - 1733 . – reference: 22) 米倉, 正大. ほか. 未破裂脳動脈瘤の治療指針 : 小未破裂脳動脈瘤の手術適応(<特集>脳血管障害におけるEBM). 脳神経外科ジャーナル. 日本脳神経外科コングレス. (2008) vol.17, no.11, p.843-849. http://search.jamas.or.jp/link/ui/2009022997 – reference: 15) OHASHI Y. Sizes of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol. (2004) vol.61, p.239-245. – reference: 19) WERMER MJH. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics. An updated meta-analysis. Stroke. (2007) vol.38, p.1404-1410. – reference: 12) MORITA A. Risk of rupture associated with intact cerebral aneurysms in the Japanese population : a systematic review of the literature from Japan. J Neurosurg. (2005) vol.102, p.601-606. |
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