title: Age limit for surgical treatment of poor-grade patients with subarachnoid hemorrhage: A project of the Chugoku-Shikoku division of the Japan neurosurgical society.
abstract: OBJECTIVE
  Management of elderly patients with poor-grade subarachnoid hemorrhage (SAH) remains controversial. The objective of this study was to investigate whether there is an age-dependent difference in the outcome of poor-grade SAH after surgical obliteration of the aneurysm.
  
  
  METHODS
  Data were reviewed retrospectively for 156 patients with poor-grade aneurysmal SAH at multiple centers in Chugoku and Shikoku, Japan. Patients were divided into age groups of 65-74 and ≥75 years old. Factors influencing a favorable outcome at discharge (Glasgow Outcome Scale, good recovery or moderately disabled) were determined using multivariate logistic regression analyses.
  
  
  RESULTS
  A favorable outcome at discharge was achieved in 37 of the 156 patients (23.7%). Advanced age (≥75 years old, P < 0.01), improvement of World Federation of Neurosurgical Societies (WFNS) Grade after admission (P = 0.02), Fisher grade (P < 0.001), and a low density area (LDA) associated with vasospasm on computed tomography (CT) (P < 0.01) were significantly associated with outcome. Multivariate analysis identified advanced age (≥75 years old, P = 0.01), Fisher group 4 (P = 0.002), and a new LDA associated with vasospasm on CT (P = 0.007) as predictors of a poor outcome in elderly patients with poor-grade SAH after surgical obliteration of the aneurysm. WFNS Grade V at admission (P = 0.052) was weakly associated with a poor outcome.
  
  
  CONCLUSIONS
  Advanced age (≥75 years old), Fisher group 4, and LDA associated with vasospasm on CT were independent predictors of clinical outcome in elderly patients with poor-grade SAH. A favorable outcome in these patients occurred more frequently after Guglielmi detachable coil embolization than after surgical clipping, but without a significant difference.
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shirao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoneda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kunitsugu
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suehiro
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Koizumi
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki