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Published in: Neuroradiology 3/2005

01-03-2005 | Interventional Neuroradiology

Treatment and outcome of aneurysmal subarachnoid haemorrhage in the elderly patient

Authors: Veit Braun, Stefan Rath, Gregor Antoniadis, Hans-Peter Richter, Wolfgang Börm

Published in: Neuroradiology | Issue 3/2005

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Abstract

From January 1999 to May 2003, 316 aneurysms were treated, among them 40 patients (12.7%) over 65 years with subarachnoid haemorrhage (SAH). The results of this sub-group are presented. Mean age was 71 years (range 65–83 years), 40% of the patients were in (Hunt & Hess) grade I–III and 60% grade IV–V. Eighty-five percent of the aneurysms were located in the anterior circulation (35% ACom aneurysms). Nineteen aneurysms were coiled (all basilar tip and small-based ACom aneurysms), two among them subsequently clipped after coil compaction, 18 were initially clipped (most of MCA and all broad-based ACom aneurysms), two wrapped and one trapped. A total of 66.7% of the patients with coiled and 60.0% with clipped aneurysms had been hospitalized in poor condition (Hunt & Hess IV–V). The average follow-up period was 16 months. Overall, 35% of patients fully recovered, 5% returned to normal activity with some deficit, 33% remained dependent and 27% died. All seven patients with MCA aneurysms and intracerebral haematoma were clipped, but died or remained vegetative. Ten of 17 coiled patients (58.8%) had a favourable outcome, compared to 4/11 (36.4%) in the clip group, but two primarily coiled aneurysms rebleld due to coil compaction. The outcome is dependent on the primary Hunt & Hess grade. A total of 48.5% of SAH patients without intracerebral bleeding fully recovered, even patients in poor primary grade. Additional intracerebral haemorrhage is linked to a bad outcome. As primary procedure, the less traumatic coiling seems to be superior to clipping primarily. Better Hunt & Hess grades have a statistically significant chance for a promising outcome.
Literature
1.
go back to reference Bracard S, Lebedinsky A, Anxionnat R, Neto JM, Audibert G, Long Y, Picard L (2002) Endovascular treatment of Hunt & Hess grade IV and V aneurysms. Am J Neuroradiol 23:953–957 Bracard S, Lebedinsky A, Anxionnat R, Neto JM, Audibert G, Long Y, Picard L (2002) Endovascular treatment of Hunt & Hess grade IV and V aneurysms. Am J Neuroradiol 23:953–957
2.
go back to reference Charpentier C, Audibert G, Guillemin F, Civit T, Ducrocq X, Bracard S, Hepner H, Picard L, Laxenaire MC (2000) Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 31 (12):3079–3083 Charpentier C, Audibert G, Guillemin F, Civit T, Ducrocq X, Bracard S, Hepner H, Picard L, Laxenaire MC (2000) Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 31 (12):3079–3083
3.
go back to reference Ferch R, Pasqualin A, Barone G, Pinna G, Bricolo A (2003) Surgical management of ruptured aneurysms in the eighth and ninth decade. Acta Neurochir 145:439–445 Ferch R, Pasqualin A, Barone G, Pinna G, Bricolo A (2003) Surgical management of ruptured aneurysms in the eighth and ninth decade. Acta Neurochir 145:439–445
4.
go back to reference Fridriksson SM, Hillman J, Säveland H, Brandt L (1995) Intracranial aneurysms surgery in the 8th and 9th decades of life: impact on population-based management outcome. Neurosurgery 37:627–632 Fridriksson SM, Hillman J, Säveland H, Brandt L (1995) Intracranial aneurysms surgery in the 8th and 9th decades of life: impact on population-based management outcome. Neurosurgery 37:627–632
5.
go back to reference Hamada J, Morioka M, Miura M, Fujioka S, Marubayashi T, Ushio Y (2001) Management outcome for ruptured anterior circulation aneurysms with Hunt and Hess clinical grade of III in patients in the 9th decade of life. Surg Neurol 56:294–300 Hamada J, Morioka M, Miura M, Fujioka S, Marubayashi T, Ushio Y (2001) Management outcome for ruptured anterior circulation aneurysms with Hunt and Hess clinical grade of III in patients in the 9th decade of life. Surg Neurol 56:294–300
6.
go back to reference Laidlaw JD, Siu KH (2002) Aggressive surgical treatment of elderly patients following subarachnoid haemorrhage: managment outcome results. J Clin Neurosci 9 (4):404–410 Laidlaw JD, Siu KH (2002) Aggressive surgical treatment of elderly patients following subarachnoid haemorrhage: managment outcome results. J Clin Neurosci 9 (4):404–410
7.
go back to reference Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, Jane JA (1996) Age and outcome after aneurysmal subarachnoid hemorrhage. Why do older patients fare worse?. J Neurosurg 85:410–418 Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, Jane JA (1996) Age and outcome after aneurysmal subarachnoid hemorrhage. Why do older patients fare worse?. J Neurosurg 85:410–418
8.
go back to reference Macdonald RL, Rosengart A, Huo D, Karrison T (2003) Factors associated with the development of vasospasm after planned surgical treatment of aneurysmal subarachnoid hemorrhage. J Neurosurg 99(4):644–652 Macdonald RL, Rosengart A, Huo D, Karrison T (2003) Factors associated with the development of vasospasm after planned surgical treatment of aneurysmal subarachnoid hemorrhage. J Neurosurg 99(4):644–652
9.
go back to reference Molyneux A (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneuryms: a randomized trial. Lancet 360:1267–1274CrossRefPubMed Molyneux A (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneuryms: a randomized trial. Lancet 360:1267–1274CrossRefPubMed
10.
go back to reference Sarkar PK, D’Souza C, Ballantyne S (2001) Treatment of aneurysmal subarachnoid haemorrhage in elderly patients. J Clin Pharmacol Ther 26:247–256 Sarkar PK, D’Souza C, Ballantyne S (2001) Treatment of aneurysmal subarachnoid haemorrhage in elderly patients. J Clin Pharmacol Ther 26:247–256
11.
go back to reference O’Sullivan M, Dorward N, Whittle IR, Steers AJ, Millers D (1994) Management and long-term outcome following subarachnoid hemorrhage and intracranial aneurysm surgery in elderly patients: an audit of 199 consecutive cases. Br J Neurosurg 8:23–30 O’Sullivan M, Dorward N, Whittle IR, Steers AJ, Millers D (1994) Management and long-term outcome following subarachnoid hemorrhage and intracranial aneurysm surgery in elderly patients: an audit of 199 consecutive cases. Br J Neurosurg 8:23–30
12.
go back to reference Torbey MT, Hauser TK, Bhardwaj A, Williams MA, Ulatowski JA, Mirski MA, Razumovsky AY (2002) Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 33(2):640–641 Torbey MT, Hauser TK, Bhardwaj A, Williams MA, Ulatowski JA, Mirski MA, Razumovsky AY (2002) Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 33(2):640–641
Metadata
Title
Treatment and outcome of aneurysmal subarachnoid haemorrhage in the elderly patient
Authors
Veit Braun
Stefan Rath
Gregor Antoniadis
Hans-Peter Richter
Wolfgang Börm
Publication date
01-03-2005
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 3/2005
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-005-1356-x

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