高齢者破裂脳動脈瘤症例における手術成績とそれに基づく手術適応

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  • Surgical Treatment in Patients over 60 Years of Age with Ruptured Cerebral Aneurysms

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The result of surgical treatment in 108 elderly cases aged over 60 years with ruptured cerebral aneurysms were analysed and were compared with that in 347 younger cases aged under 60 years. Operation using microsurgical techniques was carried out basically in cases where they were able to make a daily living without complaints and if they did not show severe complications. In some cases with Hunt and Kosnik's grade IV and V operation was carried out, but only when large intracerebral hematoma was present. Fifty-eight cases of the elderly group and 174 cases of the younger group were operated on more than 2 weeks after the bleeding. Surgical mortality and morbidity rates were 7% and 3% in the elderly group, and 1% and 4% in the younger group, respectively. Three out of 4 expired cases in the elderly group had died of an incidental disease unrelated to operative procedures. Social recovery rate in survivors was calculated by dividing the number of cases who had returned to work by the total number of survivors. This rate was 85% in the older and 88% in the younger groups. The operative result was not affected by patient's age or the location of the aneurysms, but was affected by the level of consciousness in delayed operation. Fifty cases of the elderly group and 173 cases of the younger group were operated on within 2 weeks after the bleeding. The mortality rate in cases of grade I plus II, III, N and V was 0%, 13%, 54% and 100% in the elderly group, and 1%, 9%, 26% and 57% in the younger group, respectively. The morbidity rate in cases of grade I plus II and III was 21% and 13% in the elderly group, and 9% and 6% in the younger group, respectively. Social recovery rate in survivors was 71% in the elderly group and 88% in the younger group. The following conclusions were obtained. Direct operation should be the choice of treatment in elderly patients same as in younger cases, if they were admitted more than 2 weeks after the bleeding. If they had been admitted less than 2 weeks after the hemorrhage, the operation should be carried out as soon as possible in elderly patients of grade I through III, but should not be performed in cases of grade V, even though a large intracerebral hematoma was present. In cases of grade IV, operation should be indicated, if the patients were admitted less than 24 hours after the bleeding and had a relatively small intracerebral hematoma.

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