Management Outcomes of Elderly Patients with Intracranial Aneurysms

Chun, Young Il; Ahn, Jae Sung; Kim, Jeong Hoon; Kwon, Yang; Kwun, Byung Duk

Abstract

OBJECTS: The authors analyzed the results of management outcomes for elderly subarachnoid hemorrhage patients(>65 y.o.) treated with conservative management, transcranial and endovascular surgery.
METHODS
At the authors' institution between Jan. 1997 and Aug. 1999, 104 elderly patients were treated with either conservative management or surgical management including transcranial and endovascular surgery for intracranial aneurysms. The medical recordings and neuroimaging studies of the patients were reviewed retrospectively.
RESULTS
Of the 104 patients, 90 percent of the patients were ruptured and 10% unruptured. Of the 93 patients with subarachnoid hemorrahge, 72% were in good neurological status (Hunt Hess grade I-III), 28% were in poor grade (H-H grade IV-V). Fifty one percent of the patients had a history of having other systemic illness including cardiovascular, endocrinologic and cerebrovascular disease. Ten patients of poor neurological grade were treated with conservative management. Ninety two patients were treated with transcranial surgery and 2 patients with endovascular surgery. The management outcomes of the good neurological grade (H-H grade I-III) patients with transcranial surgery was: Glasgow outcome scale (GOS) I-II 79%, GOS III 12%, GOS IV-V (death) 9%, and outcomes of the poor neurological grade (H-H grade IV-V) was GOS I-II 12%, GOS III 41%, GOS IV-V 47%. The major causes of mortality related to transcranial surgery were pneumonia, sepsis, vasospasm, acute myocardial infarction, and brain swelling. Two patients were treated successfully with endovascular surgery, and there was no death during follow-up.
CONCLUSION
This reports documents more than 80% of good neurological SAH patients undergoing treatment either transcranial or endovascular surgery can expect good clinical outcomes. So, elderly patients with good neurological grade can benifits from aggressive surgical management.