Management of Elderly Patients Older than 80 Years with Ruptured Intracranial Aneurysm

Abstract

Objectives: The aim of this investigation is to provide the strategy of management and to improve the outcomes of elderly patients older than 80 years with the ruptured intracranial aneurysm.

Methods: 18 patients over 80 years old with aneurysmal subarachnoid hemorrhage who are admitted to our institute between Jan. 1996 and Nov. 2001 were included. Mean age was 81.6 years and female was predominant (89%). Hunt and Hess grade (HHG) and Fisher grade (FG) on admission, specific management components, and clinical outcomes were recorded.

Results: HHG I to III on admission were in 11 patients (61.1%) and FG III to IV on admission were in 15 patients (83.3%). The 4-vessel angiography was performed in 13 patients and 18 aneurysms were detected with the highest percentage of posterior communicating artery aneurysm (22.8%). Aneurysm repair was performed in 12 patients；7 patients underwent surgical repair, 5 patients underwent Guglielmi detachable coil (GDC) embolization but 1 patient failed because of tortuous vessel. Preexisting medical conditions, such as hypertension (33.8%), diabetes (16.7%), myocardial disease (11.1%), cerebrovascular disease (11.1%), bronchial asthma (5.6%), were related with poor outcomes. Overall Glasgow outcome scale (GOS) were death 6 (33.3%), vegetative state and severe disability 5 (27.8%), moderate disability 0 (0%), and good recovery 7 (38.9%). Favorable outcomes of active management were 6 (50%), and favorable outcomes of GDC embolization were 3 (60%). 3 patients who had favorable clinical grade refused treatment and discharged.

Conclusions: Elderly patients with subarachnoid hemorrhage can be treated successfully and results are still improving. The development of GDC embolization may have contributed to the improved outcome. So we think that elderly patients of favorable clinical grade would have a chance of returning to an active, independent life, if treated actively.