Surgical indications to maintain quality of life in elderly patients with ruptured intracranial aneurysms.
OBJECTIVE
We performed a retrospective study to assess long-term outcomes in very old patients with ruptured intracranial aneurysms. The aim of the study was to develop guidelines for choosing surgical or conservative treatment with the goal of maintaining patients' quality of life.


METHODS
Between 1996 and 1999, 76 consecutive patients, aged 80 to 89 years, with ruptured intracranial aneurysms were treated at 18 participating centers. They were divided retrospectively into operated and nonoperated groups, and their preoperative characteristics and treatment outcomes were analyzed. Their Glasgow Outcome Scale and Barthel Index scores at least 2 years after the insult were recorded and analyzed from the perspective of their admission Hunt and Hess grade.


RESULTS
Our retrospective review encompassed 5.9 years. Of the original 76 patients, 54 (71.1%) died, 13 (17.1%) had a good outcome (Barthel Index >or=60), and 9 (11.8%) had a poor outcome (Barthel Index <60). All patients with Hunt and Hess grades of III or higher at admission had poor outcomes irrespective of treatment. Of 32 patients with an initial Hunt and Hess grade of I or II, 19 (59.4%) underwent surgery; 9 of these patients (47.4%) had good outcomes. Conversely, of 13 nonoperated patients (40.6%), only 2 (15.4%) experienced good outcomes. In seven of the nine operated patients with good outcomes, the aneurysm was small (<12 mm) and located at the internal carotid artery-posterior communicating artery junction.


CONCLUSIONS
Our results suggest that patients in the 9th decade of life with ruptured intracranial aneurysms can be considered for surgical treatment if they have a Hunt and Hess grade of I or II. The highest rate of favorable results was achieved in patients with small internal carotid artery-posterior communicating artery aneurysms.
Yano
Shigetoshi
S
Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan. yanos@kaiju.medic.kumamoto-u.ac.jp
Hamada
Jun-Ichiro
J
Kai
Yutaka
Y
Todaka
Tatemi
T
Hara
Tsuyoshi
T
Mizuno
Takamasa
T
Morioka
Motohiro
M
Ushio
Yukitaka
Y
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality