Interdisciplinary Treatment of Ruptured Intracranial Aneurysm in Patients over 80 Years

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  • 80歳以上におけるくも膜下出血の治療転帰と直達手術適応

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We retrospectively analyzed 615 consecutive patients with ruptured intracranial aneurysms to investigate surgical indications and peri-operative management in patients older than 80 years of age. <br> The patients were graded at the time of procedure, according to Hunt and Kosnik grade, and Glasgow Outcome Scale at discharge or three months follow-up. Eight-seven patients of 80 years or older were assigned to the elderly group, and the other 528 patients to the control group. <br> The rates of Hunt and Kosnik grade 4-5 were 55.2% in the elderly group and 43.6% in the control group. In the elderly group, 45 patients underwent surgical clipping, three underwent endovascular coiling, and 39 patients received conservative therapy. In the control group, 389 underwent surgical clipping, 30 coil embolization, and 109 conservative treatment. Favorable outcomes were realized in 60.4% of the control group and 18.4% of the elderly group. The GOS of every Hunt and Kosnik grade was worse in the elderly group. No significant difference was observed between surgical clipping and endovascular coiling. All of conservatively treated patients had poor outcomes. Poor outcomes in good-grade elderly patients were caused by delayed ischemic neurological deficits and systemic diseases. Favorable outcomes in patients older than 80 years of age can be obtained by careful selection of patients for optimum treatment procedures to minimize the ischemic and systemic risks. <br>

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