Current management of subarachnoid hemorrhage in advanced age.
OBJECTIVE
we focused on the recent management of aneurysmal subarachnoid hemorrhage (SAH) in patients over 70 years old (advanced age).


METHODS
from January 2001 through July 2009 we treated 372 aneurysmal SAH cases including 123 patients of advanced age. Since 2006 we have been selecting primarily interventional treatment in advanced age. We divided patients into two groups: from 2001 to 2005 and from 2006 to 2009. We analyzed Hunt-Kosnik (HK) grade, treatment methods, rate of vasospasm, Glasgow Outcome Scale at 30 days after onset of SAH, and the ratio of shunt operations. Statistical analyses were done with chi-square analysis or the t-test.


RESULTS
the ratio of procedures in advanced age increased statistically from 28% (51/183) to 38% (72/189). Mean age of patients increased from 76.2 to 77.7. HK grade and proportion of radical surgeries were similar. But the proportion of acute stage surgery and coil embolization increased significantly from 79 to 95% and from 8 to 24%, respectively. Incidence of symptomatic vasospasm increased from 35 to 37%, while asymptomatic vasospasm decreased from 4.7 to 3.2%. Rate of angioplasty increased significantly from 22 to 76%. The proportion of shunt surgeries decreased from 33 to 19% and favorable outcomes increased from 47 to 51%.


CONCLUSIONS
mean age and proportion of procedures in advanced age are increasing, but outcomes have improved. These results depend on radical surgery for aneurysm in the acute stage and aggressive prevention and treatment of vasospasm. Interventional treatment is necessary to improve the outcome in cases of advanced age.
Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki Aomori pref. 036-8562, Japan. shimab@cc.hirosaki-u.ac.jp
Norihito
N
Shimamura
Akira
A
Munakata
Hiroki
H
Ohkuma
D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005853:Geriatrics; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*