高齢者のくも膜下出血の治療適応

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  • Therapeutic Indications for Aneurysmal Subarachnoid Hemorrhage in Aged People

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We assessed the therapeutic indications for aneurysmal subarachnoid hemorrhage (SAH) in aged people. Between April 1999 and March 2002, 142 patients with aneurysmal SAH were treated and enrolled in this study. They were divided into 3 groups: 33 patients 75 years old and older (Group A, 23.2%), 37 between 65 and 74 years old (Group B, 26.1%), and 72 64 years old and younger (Group C, 47.4). Hunt and Kosnik grades, Fisher's CT classifications and clinical outcome were evaluated in each group. Clinical outcome was measured by Glasgow Outcome Scale, and good recovery and moderately disabled were defined as favorable outcome. Group A had a significantly higher incidence of serious Hunt and Kosnik grades of patients compared with the other 2 groups (p< 0.05, <0.01). Fisher's CT classification was also more severe in Group A than Group C (p<0.05). Therefore the rate of radical treatments was significantly lower in Group A (45.5%) compared with Group B (73.0%) and C (86.1%). Only 4 of the 33 patients (12.1%) with favorable outcome were in Group A, whereas the rates of favorable outcome in Group B and C were 54.1 and 62.5%, respectively. Group A had a significantly poor outcome compared with the other 2 groups. Particularly, none of the patients in Group A with Hunt and Kosnik Grades 4-5 and Fisher's Classification 4 had favorable outcome. Since there were no significant differences in the rate of radical treatments and clinical outcome between Group B and C, aged people 74 years old and younger should be actively treated in the same manner as the young. In aged people 75 years old and older, however, radical treatment should be restricted to those with Hunt and Kosnik Grade 1-3 and Fisher's CT Classification 2-3.

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