Clinical Analysis of Operation for Elderly Patients with Intracranial Aneurysms / 대한뇌혈관학회지

ABSTRACT

OBJECTIVE: Improvements in microsurgical and neuroanesthesiological techniques have resulted in an increasing number of operation for aneurysmal clipping in elderly patients.The authors evaluated surgical outcome of elderly patients, considering neurologic grade on admission, amount of subarachnoid hemorrhage (SAH) on computerized tomographic findings and timing of surgery. METHODS: The subjects of present study are 91 patients who were admitted to department of neurosurgery and treated surgically between May, 1983. and December, 1999. in Yeungnam University Hospital. The patients were classified by age into two groups: 65 to 69 years (59 cases), 70 years or older (32 cases). On admission, the clinical condition of patients was graded according to the scales of Hunt & Hess and the amount of SAH was graded according to grading system of Fisher. The timing of operation was dvided into two groups: 1-3 days (63 cases) & more than 3days (28 cases). The surgical morbidity & mortality according to Hunt & Hess grade, grading system of Fisher and timing of operation was analized. RESULTS: Overall 32 of the 91 patients were poor prognosis. And 10 of the 32 patients died, for a mortality rate 11%. There was close relationship between the preoperative Hunt & Hess grade, initial Fisher grade, operative timing & outcome. The most common causes of poor or death outcome were medical problems, i.e pulmonary dysfunction, cardiovascular disease and sepsis. The clinical factors of unfavorable outcome in the elderly patients were poor neurological grade on admission, symptomatic cerebral vasospasm, rebleeding and pre-existing medical conditions such as DM, hypertension, cardiopulmonary disease. CONCLUSION: In recent years, with improvement in surgical technique and neuroanasthesia, the number of operation for ruptured aneurysm has increased in elderly patients. We conclude that factors that most affects the clinical outcome of surgery in elderly patients were based on the neurosurgeon's technique and the patients neurological grade and concominant disease, not just on the patients age.