Management of Cerebral Aneurysms in Elderly Patientsc

Sim, Jae Hong

Abstract

In many countries, the percentage of seninor citizens is expanding. Direct operation for ruptured aneurysm should be the choice of treatment in elderly patients of Hunt-Hess grade I through III, but should not be performed in cases of grade V. To evaluate the risk of early operation of elderly patients with ruptured cerebral aneurysm, conducted a retrospective analysis 464 elderly patients with ruptured aneurysms who were over aged 60 years between Jan 1980 to June 1999. Of these, 334 cases were performed early operation in which the direct intracranial operation was carried out within 3 days after last subarachnoid hemorrhage. The female: male ratio is 4.87: 1. The location of aneurysms are 144 anterior communicating artery aneurysms, 139 internal carotid artery aneurysms, 117 middle cerebral artery aneurysms, 35 multiple aneurysms, etc. Associated conditions are hypertension, diabetes mellitus, pulmonary problem, etc. Operation methods are 404 clippings, 53 coatings, 1 endovascular treatment, etc. Problems during operation are 29 broad aneurysms, 22 giant aneurysms, 21 tight brains, etc. In early operative group(within 3 days), 79% had favorable outcome, 11% unfavorable outcome and 10% died. The early operation is an effective and reliable method to reduce the occurrence of rebleeding, vasospasm, ischemic complication, medical complication and to shorten lengths of hospitalization.