Results and Current Trends of Multimodality Treatment for Infectious Intracranial Aneurysms
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- MATSUBARA Noriaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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- MIYACHI Shigeru
- Department of Neurosurgery, Nagoya University Graduate School of Medicine Department of Neurosurgery and Endovascular Neurosurgery, Osaka Medical College
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- IZUMI Takashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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- YAMANOUCHI Takashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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- ASAI Takumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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- OTA Keisuke
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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- WAKABAYASHI Toshihiko
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
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抄録
The authors retrospectively reviewed their cases of infectious intracranial aneurysms and discuss results and trends of current treatment modalities including medical, neurosurgical, and endovascular. Twenty patients (10 males and 10 females; mean age 46 years) with 23 infectious aneurysms were treated by various treatment modalities during a 15-year period. Fifteen cases (75.0%) were caused by infective endocarditis. Eleven aneurysms (47.8%) were ruptured. Two aneurysms (8.7%) presented a mass effect and 7 (30.4%) were unruptured and asymptomatic. The average aneurysm size was 6.5 ± 4.8 mm (range 1–22 mm). The aneurysms were located in proximal cerebral circulation in 7 (30.4%) and distal in 16 (69.6%). Six (26.1%) aneurysms were treated surgically (5: trapping, 1: neck clipping), 10 (43.5%) endovascularly (7: trapping, 2: proximal occlusion, 1: saccular coiling), and the remaining 7 (30.4%) medically. Endovascular treatment was gradually increased with time. Medical and surgical treatments were continuously performed during the study period. Surgery was preferred for the patient with intraparenchymal hematoma or treated by bypass surgery. Three periprocedural minor complications occurred in endovascular treatment. There was one postoperative infarction with permanent deficit developed from surgical treatment. During the follow-up period (mean 28.8 months), none of the aneurysms presented a recurrence or rebleeding. Thirteen patients (65.0%) had favorable clinical outcomes (modified Rankin Scale: 0–2), although four (20.0%) had poor outcomes (modified Rankin Score: 5–6). A multimodal approach for the management of infectious aneurysms achieved satisfactory results. Endovascular intervention is a feasible and efficacious treatment option and surgical intervention is still an indispensable procedure.
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 55 (2), 155-162, 2015
一般社団法人 日本脳神経外科学会