Clipping surgery for aneurysmal subarachnoid hemorrhage in patients aged 75 years or older

Abstract

Object: The incidence rate of aneurysmal subarachnoid hemorrhage (SAH) in the elderly is increasing. Although endovascular coiling has become a major form of treatment for SAH in elderly patients, not all ruptured aneurysms can be managed with an endovascular approach.Conventional surgical clipping still plays an important role in SAH treatment. The present study was performed to assess the outcome in patients older than 75 years of age in whom ruptured aneurysms were treated by clipping surgery. Results: A total of 333 patients were analyzed. There were significant differences in preoperative grade, Fisher grade, and location of the aneurysm between the favorable and unfavorable outcome groups. In multivariate logistic regression analysis, independent predictors of unfavorable outcome were poor grade and ruptured anterior cerebral artery aneurysm, but not age of 80 years or older. Conclusions:Advanced age did not represent a risk factor for poor outcome of clipping surgery in elderly patients. Although coil embolization has been shown to be a useful form of treatment, direct surgery should also be considered.Running title: Clipping surgery of ruptured aneurysms in the elderly

Aneurysmal Subarachnoid Hemorrhage in the Elderly over Age 75: A Systematic Review

“…Of two articles by Horiuchi et al, the latest one with more cases was excluded, because it investigated cases 80 years of age or older, while the older one investigated cases 75 years of age or older. 11 , 12) Two articles by Hamada et al had no overlap of cases, and both articles were included. 13 , 14) Two articles by Asano et al were from different institutions and had no overlap of cases; both were therefore included.…”

“…A comparative investigation with other time-spans under age 75 was performed in three studies, 5 , 17 , 18) and a comparative investigation between several time-spans of 75 or 80 years of age or older was performed in three studies. 4 , 11 , 17) One article investigated mainly a comparison among different time spans, while the data for the patients over 75 years of age included outcome only. 17) Of 12 articles, eight studies were performed in Japan, and the other four studies were performed in several developed countries.…”

Age limit for surgical treatment of poor-grade patients with subarachnoid hemorrhage: A project of the Chugoku-Shikoku division of the Japan neurosurgical society

“…Recently, Horiuchi et al . [5] suggested that advanced age was not a risk factor for a poor outcome of clipping surgery in elderly patients, and Karamanakos et al . [8] suggested that integration of coil treatment in clinical practice has not improved the overall outcome of SAH in the elderly.…”

Is aneurysm repair justified for the patients aged 80 or older after aneurysmal subarachnoid hemorrhage?

“…However, these studies were based on observational ones of the surgical group without any control group,3 or historical control groups,4 or case-control studies which compared between the elderly 5 6. To date, there has been no study which compared the elderly patients of aSAH who received clip/coil treatment with those who did not.…”