Clinical Analysis of Aneurysmal Subarachnoid Hemorrhage in Elderly Patients

Kim, Hyun Woo; Lee, Jung Kil; Kim, Tae Sun; Jung, Shin; Kim, Jae Hyoo; Kim, Soo Han; Kang, Sam Suk; Lee, Je Hyuk

Abstract

In order to determine the advisability of surgical intervention, 61 patients aged 66 or over and 481 patients aged 65 or less, who during the five-year period January, 1991 to December, 1995 had undergone surgery for aneurysmal subarachnoid hemorrhge, were retrospectively analysed in terms of clinical characteristics, operative outcome and factors affecting it, and were compared. The overall female to male sex ratio was 1.6: 1 while(1.49: 1 in the younger group and 3.36: 1 in the older group), showing a female preponderance with increasing age. Hunt-Hess admission grades I and II accounted for 61.1% of the younger and 44% of the elderly group. Between the two groups, there was no significant difference in the site of aneurysms, but those measuring 12 to 24mm were more frequently found in the elderly(29.5%) than in the younger group(16%; p<0.05). The incidences of rebleeding and symptomatic vasospasm were not different between the two groups but there was an increased incidence of hydrocephalus in the older group(19.7% versus 8.1% for the younger group)(p<0.05). Favorable outcome, defined according to the Glasgow outcome scale as good recovery or moderately disabled, was 84.2% for the younger group and 72.2% for the elderly group but surgical outcome did not differ according to preoperative grade. The major causes of disability and death were the direct effect of bleed(7%) and rebleeding(7%) in the younger group , and operative complications(14.7%), medical complications(11.5%) in the elderly group. The less favorable outcome among elderly patients was attributed to their poorer admission grades and greater frequency of initial intracerebral hemorrhage. We conclude that for elderly patients presenting with good admission grades and general condition, an aggressive approach with surgical treatment with regard to intraoperative hemodynamic fluctuations and preexisting conditions is indicated.