未破裂脳動脈瘤患者における無症候性出血 (silent hemorrhage) についての研究
未破裂脳動脈瘤連続300症例のclipping術の術中所見から, 8個 (2.7%) の瘤で無症候性出血 (silent hemorrhage) を認めた. Silent hemorrhageを認めた瘤では最大径が平均5.4mmと小さく, 術前のbleb検出率も25%と少なかった. 多変量解析では動脈瘤最大径と高血圧症がsilent hemorrhageをきたすリスクとして有意傾向を認めた. 以上よりsilent hemorrhageをきたした瘤は, 比較的小型のときに3DCTAによる画像診断では検出しづらい小型のbleb (blister) が無症候性の微小出血をきたしたものと考えられた....
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| Published in | 脳神経外科ジャーナル Vol. 30; no. 3; pp. 224 - 229 |
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| Main Authors | , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.30.224 |
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| Abstract | 未破裂脳動脈瘤連続300症例のclipping術の術中所見から, 8個 (2.7%) の瘤で無症候性出血 (silent hemorrhage) を認めた. Silent hemorrhageを認めた瘤では最大径が平均5.4mmと小さく, 術前のbleb検出率も25%と少なかった. 多変量解析では動脈瘤最大径と高血圧症がsilent hemorrhageをきたすリスクとして有意傾向を認めた. 以上よりsilent hemorrhageをきたした瘤は, 比較的小型のときに3DCTAによる画像診断では検出しづらい小型のbleb (blister) が無症候性の微小出血をきたしたものと考えられた. |
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| AbstractList | 未破裂脳動脈瘤連続300症例のclipping術の術中所見から, 8個 (2.7%) の瘤で無症候性出血 (silent hemorrhage) を認めた. Silent hemorrhageを認めた瘤では最大径が平均5.4mmと小さく, 術前のbleb検出率も25%と少なかった. 多変量解析では動脈瘤最大径と高血圧症がsilent hemorrhageをきたすリスクとして有意傾向を認めた. 以上よりsilent hemorrhageをきたした瘤は, 比較的小型のときに3DCTAによる画像診断では検出しづらい小型のbleb (blister) が無症候性の微小出血をきたしたものと考えられた. |
| Author | 山本, 拓史 松崎, 粛統 渡邉, 貞義 佐々木, 裕亮 沼澤, 真一 和田, 孝次郎 酒井, 淳 吉田, 浩貴 森, 健太郎 山川, 功太 伊藤, 康信 赤須, 功 北川, 亮 豊岡, 輝繁 田中, 将大 |
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| References | 3) Guo Y, Saunders T, Su H, Kim H, Akkoc D, Saloner DA, Hetts SW, Hess C, Lawton MT, Bollen AW, Pourmohamad T, McCulloch CE, Tihan T, Young WL : Silent intralesional microhemorrhage as a risk factor for brain arteriovenous malformation rupture. Stroke 43 : 1240-1246, 2012. 12) Shojima M, Nemoto S, Morita A, Oshima M, Watanabe E, Saito N : Role of shear stress in the blister formation of cerebral aneurysm. Neurosurgery 67 : 1268-1275, 2010. 8) Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Takeuchi S, Yamamoto T, Nakao Y, Arai H : Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms. J Neurosurg 130 : 1359-1366, 2019. 9) Nakagawa D, Kudo K, Awe O, Zanaty M, Nagahama Y, Cushing C, Magnotta V, Hayakawa M, Allan L, Greenlee J, Awad IA, Carroll T, Torner J, Raghavan ML, Hasan DM : Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping : Pilot study. J Neurosurg 130 : 1391-1397, 2018. 5) Jakobsson KE, Säveland H, Hillman J, Edner G, Zygmunt S, Brandt L, Pellettieri L : Warning leak and management outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 85 : 995-999, 1996. 7) Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Fujii K, Kumagai K, Takeuchi S, Tomura S, Yamamoto T, Nakao Y, Arai H : Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms. J Neurosurg 127 : 1307-1314, 2017. 11) Prayer L, Wimberger D, Stiglbauer R, Kramer J, Richling B, Bavinzski G, Crech T, Imhof H : Haemorrhage in intracerebral arteriovenous malformations : detection with MRI and comparison with clinical history. Neuroradiology 35 : 424-427, 1993. 13) Takada S, Inoue T, Niizuma K, Shimizu H, Tominaga T : Hemosiderin detected by T2＊-weighted magnetic resonance imaging in patients with unruptured cerebral aneurysms : Indication of previous bleeding? Neurol Med Chir (Tokyo) 51 : 275-281, 2011. 1) Abla AA, Nelson J, Kim H, Hess CP, Tihan T, Lawton MT : Silent arteriovenous malformation hemorrhage and the recognition of “unruptured” arteriovenous malformation patients who benefit from surgical intervention. Neurosurgery 76 : 592-600, 2015. 2) 浅野太郎, 松尾彩香, 森塚倫也, 本田和也, 日宇 健, 川原一郎, 小野智憲, 原口 渉, 牛島隆二郎, 堤 圭介 : 脳動脈瘤周囲浮腫の意義―Minor leakを示唆する間接所見の可能性について―. No Shinkei Geka 48 : 47-54, 2020. 4) Ishii D, Nakagawa D, Zanaty M, Roa JA, Kasab SA, Shaban A, Hudson JS, Osorno-Cruz C, Byer S, Allan L, Torner JC, Awad IA, Carroll TJ, Samaniego EA, Hasan DM : Quantitative susceptibility mapping and vessel wall imaging as screening tools to detect microbleed in sentinel headache. J Clin Med 9 : 979, 2020. 6) Leblanc R : The minor leak preceding subarachnoid hemorrhage. J Neurosurg 66 : 35-39, 1987. 10) Nussbaum ES, Defillo A, Zelensky A, Pulivarthi S, Nussbaum L : “Microbleeding” from intracranial aneurysms : Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms. Surg Neurol Int 5 : 28, 2014. |
| References_xml | – reference: 1) Abla AA, Nelson J, Kim H, Hess CP, Tihan T, Lawton MT : Silent arteriovenous malformation hemorrhage and the recognition of “unruptured” arteriovenous malformation patients who benefit from surgical intervention. Neurosurgery 76 : 592-600, 2015. – reference: 4) Ishii D, Nakagawa D, Zanaty M, Roa JA, Kasab SA, Shaban A, Hudson JS, Osorno-Cruz C, Byer S, Allan L, Torner JC, Awad IA, Carroll TJ, Samaniego EA, Hasan DM : Quantitative susceptibility mapping and vessel wall imaging as screening tools to detect microbleed in sentinel headache. J Clin Med 9 : 979, 2020. – reference: 6) Leblanc R : The minor leak preceding subarachnoid hemorrhage. J Neurosurg 66 : 35-39, 1987. – reference: 13) Takada S, Inoue T, Niizuma K, Shimizu H, Tominaga T : Hemosiderin detected by T2＊-weighted magnetic resonance imaging in patients with unruptured cerebral aneurysms : Indication of previous bleeding? Neurol Med Chir (Tokyo) 51 : 275-281, 2011. – reference: 10) Nussbaum ES, Defillo A, Zelensky A, Pulivarthi S, Nussbaum L : “Microbleeding” from intracranial aneurysms : Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms. Surg Neurol Int 5 : 28, 2014. – reference: 11) Prayer L, Wimberger D, Stiglbauer R, Kramer J, Richling B, Bavinzski G, Crech T, Imhof H : Haemorrhage in intracerebral arteriovenous malformations : detection with MRI and comparison with clinical history. Neuroradiology 35 : 424-427, 1993. – reference: 3) Guo Y, Saunders T, Su H, Kim H, Akkoc D, Saloner DA, Hetts SW, Hess C, Lawton MT, Bollen AW, Pourmohamad T, McCulloch CE, Tihan T, Young WL : Silent intralesional microhemorrhage as a risk factor for brain arteriovenous malformation rupture. Stroke 43 : 1240-1246, 2012. – reference: 9) Nakagawa D, Kudo K, Awe O, Zanaty M, Nagahama Y, Cushing C, Magnotta V, Hayakawa M, Allan L, Greenlee J, Awad IA, Carroll T, Torner J, Raghavan ML, Hasan DM : Detection of microbleeds associated with sentinel headache using MRI quantitative susceptibility mapping : Pilot study. J Neurosurg 130 : 1391-1397, 2018. – reference: 7) Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Fujii K, Kumagai K, Takeuchi S, Tomura S, Yamamoto T, Nakao Y, Arai H : Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms. J Neurosurg 127 : 1307-1314, 2017. – reference: 8) Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Takeuchi S, Yamamoto T, Nakao Y, Arai H : Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms. J Neurosurg 130 : 1359-1366, 2019. – reference: 5) Jakobsson KE, Säveland H, Hillman J, Edner G, Zygmunt S, Brandt L, Pellettieri L : Warning leak and management outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 85 : 995-999, 1996. – reference: 12) Shojima M, Nemoto S, Morita A, Oshima M, Watanabe E, Saito N : Role of shear stress in the blister formation of cerebral aneurysm. Neurosurgery 67 : 1268-1275, 2010. – reference: 2) 浅野太郎, 松尾彩香, 森塚倫也, 本田和也, 日宇 健, 川原一郎, 小野智憲, 原口 渉, 牛島隆二郎, 堤 圭介 : 脳動脈瘤周囲浮腫の意義―Minor leakを示唆する間接所見の可能性について―. No Shinkei Geka 48 : 47-54, 2020. |
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| Snippet | 未破裂脳動脈瘤連続300症例のclipping術の術中所見から, 8個 (2.7%) の瘤で無症候性出血 (silent hemorrhage) を認めた. Silent hemorrhageを認めた瘤では最大径が平均5.4mmと小さく, 術前のbleb検出率も25%と少なかった.... |
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| SubjectTerms | cerebral aneurysm clipping silent hemorrhage |
| Title | 未破裂脳動脈瘤患者における無症候性出血 (silent hemorrhage) についての研究 |
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