title: Treatment and outcome of aneurysmal subarachnoid haemorrhage in the elderly patient.
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 rebled 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.
authors.affiliation: Department of Neurosurgery, Evangelisches Jung-Stilling Krankenhaus Siegen, Wichernstr 40, 57075, Siegen, Germany. veit.braun@diakonie-siegen.de
authors.forename: Veit
authors.initials: V
authors.lastname: Braun
authors.forename: Stefan
authors.initials: S
authors.lastname: Rath
authors.forename: Gregor
authors.initials: G
authors.lastname: Antoniadis
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Richter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Börm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome