후방순환계 뇌동맥류의 임상분석
Management Outcome in Cerebral Aneurysms of Posterior Circulation
소속 상세정보
임동준/Dong-Jun Lim
이훈갑/정흥섭/김봉룡/권택현/이기찬/서중근/Hoon-Kap Lee/Heung-Seob Chung/Bong-Ryong Kim/Taek-Hyeun Kwon/Ki-Chan Lee/Jung Keum Suh
KMID : 0359819980270111576
Abstract
결 론
저자들은 본 연구를 통하여 다음과 같은 결론을 얻었다.
1) 사망의 원인으로 술 전 재출혈이 가장 많아 후방순환계 뇌동맥류에서도 조기치료를 적
극적으로 시행하여 재출혈로 인한 사망을 줄여 예후를 향상시키는 데 기여할 수 있을 것으
로 사료되었다.
2) 후방순환계의 뇌동맥류에서도 내원시 H-H등급이 예후에 영향을 미칠 수 있는 요소로
사료되었으며, 특히 근위부의 동맥류가 원위부에 발생한 경우에 비하여 치료결과가 좋아, 개
체수가 적은 이유로 통계적인 유의성을 얻을 수는 없었으나 동맥류의 위치가 수술결과에 영
향을 미치는 가장 중요한 요소 중의 하나로 사료되었다.
3) 후방순환계 뇌동맥류의 치료에 비수술적 혈관내치료가 단기간의 예후를 향상시키는 데
유용한 대체치료방법으로 사료되었고, 향후 장기간의 추적관찰이 필요하지만 후방 순환계
동맥류의 치료에 혈관내 치료를 적극적으로 시행하는 것이 단기간의 예후 향상에 바람직할
것으로 사료되었다.
#초록#
A series of 51 consecutive patients with 55 cerebral aneurysms of the vertebrobasilar
system is presented. Thirty aneurysms had their origins at the basilar artery(BA)
bifurcation. 7 at the origin of the cerebeller artery (SCA). 4 at the posterior cerebral
artery(PCA), 4 at the BA trunk. 8 from the vertebral artery(VA) at the origin of the
posterior inferior cerebellar artery(PICA). 4 at the BA trunk. 8 from the vertebral
artery(VA) at the origin women and 21 men. with a mean age of 50 years(range 30-70
years). The overall mortality and morbidity rates at 6 months were 17.6%(9/51) and
13.7%(7/51), respectively. The common cause of death was rebleeding(55.6%, 5/9).
Nineteen patients had underwent only conservative treatment due to aneurysms
classified as inoperable(6 cases), fatal rebleeding(5 cases). refusal against surgery(5
cases), poor Hunt and Hess grade that did not improve(2 cases), and one aneurysm that
spontaneously disappeared. Treatments consisted of neck clipping in 16 patients.
wrapping in 6, and endovascular therapy in 10. All of these treatment modalities were
carried out after 2 weeks, wrapping in 6, and endovascular therapy in 10. All of these
treatment modalities were carried out after 2 weeks from initial insult. Treatment
outcome was evaluated with Glasgow Outcome Scale(GOS) at 6 months after initial
insult. patients with Hunt and Hess(H-H) Grades Ⅰ and Ⅱ at admission good outcome
in 70.6%, whereas only 60 % of patients with H-H Grades Ⅲ and Ⅳ showed good
outcome. But there no statistically significant difference. Five patients with aneurysms
which were located proximally had outcome than those with distal aneurysm(100% good
outcome vs 66.7%). All of ten patients who were treated with endovascular therapy
showed outcome, whereas only 13 out of 22(59.1%) patients who underwent either
clipping or wrapping showed good outcome. There was statistically significant differance
(p<0.05). As for the comparison of outcome according to the size of aneurysm and age
of aneurysm and age of patients, we found no statistically significant differance. these
results indicated that the location of aneurysm was one of important prognostic factor in
vertebrobasilar system. Endovascular treatment may be a promising treatment option and
considering the very high mortality from rebleeding early management contribute to
reduce the option and considering the very high mortality from rebleeding early
management may contribute to reduce the mortality and morbidity in posterior
circulation aneurysm.
키워드
Cerebral aneurysm; Endovascular treatment; Posterior circulation aneurysm; Subarachnoid hemorrhage.;
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