未破裂脳動脈瘤根治術の問題点とtailor-made medicine  [in Japanese] Tailor-made Strategy for Treating Patients with Unruptured Cerebral Aneurysm  [in Japanese]

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Abstract

The indications for radical surgery to treat unruptured cerebral aneurysms (uAN) remain unclear. Most investigations of evidence-based medicine have focused on prognostic factors such as the natural history, surgical outcome, risk-benefit analysis, and socioeconomic effects, and not on patient factors such as decision-making, anxiety, or satisfaction. This study undertook a survey of these factors in 172 patients who underwent radical surgery during the last 7 years, using a mail questionnaire sent to a third person. The total response rate was 53.5%. Almost 90% of patients could understand the explanation of their condition including the presence of uAN and risk of bleeding, and the proposed treatment. About 70 percent of patients (70.9%) selected the type of treatment from among observation, clipping, or coiling, and 72.8% decided on the same day as the explanation. Patient decision-making was affected by anxiety about bleeding (49.3%) and recommendation by the attending physician (43.2%). The delay from the decision to the operation was 1 month or less in half of the patients, but more than 6 months in about 20%. Sixty-nine patients with asymptomatic aneurysms found on brain examination were treated by clipping, and 10 with asymptomatic aneurysms by coil embolization. Eighty-one patients with aneurysms causing SAH or neurological symptoms were treated by clipping, and 12 with giant aneurysms underwent other surgery. Visual analogue scale analysis found that 75% of all patients were satisfied, but 91.6% of patients who underwent coil embolization were highly satisfied. The most common factor causing dissatisfaction was anxiety during the delay from the explanation to the surgical treatment (44%). Almost half of the patients complained of several problems other than neurological symptoms such as the surgical wound. This study indicates that patient decision-making was highly affected by the explanation of the physician, especially the recommendation for treatment and the sense of anxiety about the possibility of aneurysm rupture. Patient anxiety should be minimized by collecting better evidence about the natural history, surgical risk, and recurrence of uAN. The reaction of individual patients to the potential risks and possibilities of surgical intervention differed enormously, so a tailor-made approach to individuals to support patient decision-making should be formulated.

Journal

  • 脳卒中の外科 = Surgery for cerebral stroke

    脳卒中の外科 = Surgery for cerebral stroke 31(2), 98-103, 2003-03-31

References:  34

Cited by:  2

  • Problems in Preservation of Blood Flow of Efferent Artery from Unruptured Cerebral Aneurysms at the Time of Clipping Surgery  [in Japanese]

    ISHIKAWA Tatsuya , KAMIYAMA Hiroyasu , KAZUMATA Ken , TAKIZAWA Katsumi , NAKAYAMA Naoki , NOMURA Mikio , KURODA Satoshi , IWASAKI Yoshinobu , Tatsuya ISHIKAWA , Hiroyasu KAMIYAMA , Ken KAZUMATA , Katsumi TAKIZAWA , Naoki NAKAYAMA , Mikio NOMURA , Satoshi KURODA , Yoshinobu IWASAKI , 北海道大学大学院医学研究科脳神経外科 , 旭川赤十字病院脳神経外科 , 旭川赤十字病院脳神経外科 , 旭川赤十字病院脳神経外科 , 北海道大学大学院医学研究科脳神経外科 , 渓和会江別病院脳神経外科 , 北海道大学大学院医学研究科脳神経外科 , 北海道大学大学院医学研究科脳神経外科 , Department of Neurosurgery Hokkaido Graduate School of Medicine , Department of Neurosurgery Asahikawa Red-Cros Hospital , Department of Neurosurgery Asahikawa Red-Cros Hospital , Department of Neurosurgery Asahikawa Red-Cros Hospital , Department of Neurosurgery Hokkaido Graduate School of Medicine , Department of Neurosurgery Keiwa-kai Ebetsu Hospital , Department of Neurosurgery Hokkaido Graduate School of Medicine , Department of Neurosurgery Hokkaido Graduate School of Medicine

    脳卒中の外科 = Surgery for cerebral stroke 32(2), 79-85, 2004-03-31

    Ichushi Web  References (19) Cited by (2)

  • Management of Unruptured Intracranial Aneurysms Associated with Ischemic Complication  [in Japanese]

    SUZUKI Michiyasu , KATO Shouichi , AKIMURA Tatsuo , ISHIHARA Hideyuki , FUJII Masami , KAJIWARA Koji , NOMURA Sadahiro , SUEHIRO Eiichi , YOSHIKAWA Kouichi , FUJISAWA Hirosuke , Michiyasu SUZUKI , Shouichi KATO , Tatsuo AKIMURA , Hideyuki ISHIHARA , Masami FUJII , Koji KAJIWARA , Sadahiro NOMURA , Eiichi SUEHIRO , Kouichi YOSHIKAWA , Hirosuke FUJISAWA , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , 山口大学医学部脳神経病態学脳神経外科 , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine , Department of Neurosurgery Clinical Neuroscience Yamaguchi University School of Medicine

    脳卒中の外科 = Surgery for cerebral stroke 32(2), 126-132, 2004-03-31

    Ichushi Web  References (30) Cited by (2)

Codes

  • NII Article ID (NAID)
    110003739534
  • NII NACSIS-CAT ID (NCID)
    AN10061756
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09145508
  • Data Source
    CJP  CJPref  NII-ELS 
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