Fukutaro Ohgaki, Takashi Shuto, Shigeo Matsunaga, Nagatsuki Tomura, Jo Sasame, Kazuki Miyazaki, Kei Iwamoto, So Ozaki
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引用次数: 0
Abstract
Background: Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory vascular disease, initially reported in 1976 by Slavin and Gonzalez-Vitale. SAM-associated cerebral aneurysms have been reported in limited cases, and the disease entity is not fully understood. Therefore, we propose a diagnostic and treatment strategy with a systematic review of previously reported cases and our cases.
Methods: We systematically searched cases of SAM-associated cerebral aneurysms using an online database. The findings of each included study and our cases were systematically reviewed in terms of characteristics, aneurysm, and clinical course.
Results: In addition to our 2 cases, 41 cases from 32 publications were included. SAM-associated cerebral aneurysms were common among East Asians, particularly Japanese, aged 40-50 years, and typically presented as subarachnoid hemorrhage (SAH; 86%). Most aneurysms (75%) were dissection aneurysms. Subarachnoid hemorrhage (SAH) cases had a higher risk of successive intra-abdominal hemorrhage (IAH) caused by visceral aneurysm rupture (59%), with a mortality of 41%. It was most likely to occur 8.2 ± 7.3 days after SAH. If operations were accomplished, the prognosis was relatively good (modified Rankin Scale score 0-3; 71%).
Conclusions: SAM-associated cerebral aneurysms can be life-threatening because of the risk of rupture and can lead to successive IAH after SAH. However, the prognosis is relatively good if an operation is successful. Therefore, precise diagnosis is required for suspected cases at first, and appropriate surgical treatment is required. Moreover, appropriate management of successive IAH is required among patients with SAH.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS