title: Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome.
abstract: OBJECTIVE
  To determine the outcome of treatment of microsurgical clipping in elderly (60 - 70 years) patients with aneurysmal subarachnoid hemorrhage and determine the predictors of poor outcome.
  
  
  METHODS
  Longitudinal analytical study.
  
  
  METHODS
  Nishtar Hospital, Multan, Mayo Hospital, Lahore, Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2000 to January 2010.
  
  
  METHODS
  Elderly patients (60 - 70 years) with ruptured cerebral aneurysm were enrolled and graded on the basis of World Federation of Neurosurgeons Scale (WFNS). Aneurysm sac obliteration was done in all the patients with microsurgical clipping. Postoperatively, the patients were assessed upto 3 months for outcome parameters i.e., neurological deterioration (based on WFNS grade and modified Rankin scale as favourable (mRS score ² 2) and unfavourable (mRS score > 2). The factors associated with unfavourable outcome were also noted which included age > 65 years, poor initial WFNS grade, and the occurrence of ischaemia.
  
  
  RESULTS
  The mean age of the 48 patients was 65 + 5.45 years. There were 31 (64.6%) male and 17 (35.4%) female patients. Postprocedural neurological deterioration occurred in 23 patients (47.9%) related to ischaemia in 14 (29.16%), rebleeding in 1 (2%), and hydrocephalus in 8 (16.66%). At 03 months, the outcome was favourable in 25 patients (52.08%) and unfavourable in 23 (47.91%).
  
  
  CONCLUSIONS
  In old patients, careful pre-operative assessment, interdisciplinary approach and meticulous tissue handling during aneurysm clipping may decrease the unfavourable outcome.
authors.affiliation: Department of Neurosurgery, PGMI / Lahore General Hospital, Lahore. drliaqatawan@hotmail.com
authors.forename: Liaqat Mahmood
authors.initials: LM
authors.lastname: Awan
authors.forename: Abdullah
authors.initials: A
authors.lastname: Haroon
authors.forename: Mukhtar
authors.initials: M
authors.lastname: Ahmed
authors.forename: Abdul
authors.initials: A
authors.lastname: Majid
authors.forename: Muhammad Asif
authors.initials: MA
authors.lastname: Shabir
authors.forename: Azam
authors.initials: A
authors.lastname: Niaz
authors.forename: Abdul
authors.initials: A
authors.lastname: Jaleel
authors.forename: Muhammad Naeem
authors.initials: MN
authors.lastname: Kasuri
authors.forename: Anjum Habib
authors.initials: AH
authors.lastname: Vohra
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D009460:Neurologic Examination; D019635:Neurosurgical Procedures; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed