title: Clinical outcomes of treatment for intracranial aneurysm in elderly patients.
abstract: OBJECTIVE
  The aim of this study is to evaluate the clinical course of intracranial aneurysm in patients aged 65 years and older and the immediate outcome after its aggressive management.
  
  
  METHODS
  We performed a retrospective analysis using the medical records of 159 elderly patients managed at our institute from September 2008 to December 2013. Obtained clinical information included age, sex, Hunt and Hess grade (HHG), aneurysm location, Fisher grade (FG) and the treatment modality. Concomitant clinical data aside from cerebrovascular condition (hypertension, diabetes, previous medication) were evaluated to determine risk factors that might affect the functional outcomes.
  
  
  RESULTS
  A total of 108 patients (67.9%) presented with subarachnoid hemorrhage (SAH), and 51 (32.1%) with unruptured intracranial aneurysms (UIAs). Coiling was performed in 101 patients and 58 patients underwent clipping. In the SAH population, 62 patients (57.4%) showed favorable outcomes, with a mortality rate of 11.3% (n = 18). In the UIAs population, 50 (98%) patients achieved 'excellent' and one (2%) achieved 'good' outcome. Factors including high-grade HHG (p < 0.001), advanced age (p = 0.014), and the presence of intraventricular hematoma (IVH) (p = 0.017) were significant predictors of poor outcome.
  
  
  CONCLUSIONS
  SAH patients with high grade HHG and IVH are associated with poor outcome with statistical significance, all the more prominent the older the patient is. Therefore, the indication for aggressive therapy should be considered more carefully in these patients. However, as the outcomes for elderly patients with UIAs were excellent regardless of the treatment modality, aggressive treatment could always be considered in UIAs cases.
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Young Im
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yong Cheol
authors.identifier: 0000-0002-5719-2483
authors.initials: YC
authors.lastname: Lim
keywords: Elderly; Endovascular coiling; Intracranial aneurysm; Microsurgical clipping; Outcome; Subarachnoid hemorrhage