비파열성 뇌동맥류의 수술과 연관된 합병증 = Surgery Related Complication of Unruptured Cerebral Aneurysm

국문 초록 (Abstract)

비파열성 뇌내 동맥류의 크기, 위치, 환자의 나이에 따라 치료결정에 대한 논란이 많으나 적극적인 치료가 증가 추세이다. 문헌상 파열성 뇌내 동맥류보다 수술 합병증의 빈도는 덜하지만, 새로운 뇌경색이나 수술 부위와 떨어진 소뇌의 출혈과 같은 예기치 못한 합병증이 보고되고 있다. 비파열성 뇌내 동맥류는 수술 전에 증상이 없거나 심각하지 않으므로 수술이 더 용이하다고 해서 쉽게 생각하는 것은 절대 금물이고, 보호자에서 충분한 사전 설명과 함께 위험성과 효율과의 비율을 정확히 고려해야 할 것이다.

다국어 초록 (Multilingual Abstract)

Background: With advances in neuroimaging, unruptured cerebral aneurysms are being diagnosed more frequently. Surgery is warranted if surgical risk are less than the risk of natural history. In this study, we investigated the surgery related complications and its prognosis after clipping of unruptured cerebral aneurysms.
Methods: The study consists of a retrospective review of 100 patients who underwent surgery performed by one surgeon for 110 unruptured aneurysms between January, 1990 and December, 2006. One hundred and two aneurysms(92.7%) were successfully clipped, and 8(6.4%) were either wapped or trapped. The clinical outcomes were evaluated in each patient by the Glasgow Outcome Scale at discharge.
Results: Thirty(30%) of the patients were asymptomatic, while the remainder(70%) had various symptoms. Regarding the aneurysmal size, 4(3.6%) were giant aneurysms, and 88(80%) were small aneurysms less than 10mm in diameter. The location of the aneurysms were internal carotid artery, middle cerebral artery, anterior cerebral artery in order of frequency. Ninety eight patients recovered without any neurological deficits. A procedure-related surgical complication was diagnosed in 2 cases(2%). Complications included hemiparesis(moderately disabled) following cerebral infarction.
Conclusion: The morbidity rate associated with treating unruptured aneurysms is not negligible with increasing trend of active management decision in patients with unruptured aneurysms. Treatment requires accurate assessment of the risk/benefit ratio considering natural history of the disease, and unpredictable complication ratio should be closely monitored.