Management of Cerebral Aneurysms in Elderly Patients

Abstract

The number of elderly patients admitted with diagnosis of cerebral aneurysms is markedly increasing worldwide. Treatment in this group of patients is certainly more difficult than in the young subjects and not many reports deal with their management.Many factors must be considered deciding if to pursue treatment. Patients admitted after bleeding (subarachnoid haemorrhage, SAH) have a different prognosis from young subjects and those harboring unruptured vascular malformations.We have analyzed the literature on the basis of this distinction.La gestione degli aneurismi cerebrali nei pazienti anziani Analisi della letteratura RIASSUNTO -Il numero di pazienti anziani ricoverati con diagnosi di aneurismi cerebrali è marcatamente aumentato in tutto il mondo. Il trattamento di questo tipo di pazienti è certamente più difficile che non nei soggetti giovani, solo pochi articoli sono dedicati a questo problema.Molti fattori vanno presi in considerazione nel decidere se proseguire nel trattamento. I pazienti ricoverati dopo un'emorragia subaracnoidea hanno una prognosi differente dai giovani e da coloro che presentano malformazioni vascolari non rotte.Abbiamo analizzato la letteratura sulla base di questa distinzione.Ricevuto il 06.08.2002 Management of Cerebral Aneurysms in Elderly PatientsF. Griva 598 more likely to have occurred and elevated blood pressure seems to be related to the severity of age 9 .As an adjunctive consideration it is important to notice that basic mechanisms responsible for the damage to the aged brain are not completely understood. Lanzino et Al 16 describe the possibility of a cellular time-dependent loss of structure and function, an impairment in mRNA translation, a decrease of the number of mitochondria with age and a lowered reactive synaptogenesis in response to any neuronal insult. According to cerebral vasospasm, other aspects can be described. After SAH the entity of blood in the first CT scan is related to the subsequent development of vasospasm 7 .In elderly patients, in spite of the usually thicker clot on CT, the incidence of angiographic vasospasm is lower than expected. Even if vascular narrowing in angiography is less frequently encountered in elderly patients, the incidence of symptomatic vasospasm is similar to that described in younger subjects. Lanzino et Al 16 described an increase in clinical vaospasm in elderly patients. In their series, patients older than 70 years were more likely to suffer permanent neuological morbidity from vasospasm. This can be considered a consequence of the decreased cerebral blood flow with advancing age 24,25 . After SAH an impairment of cerebrovascular reactivity is known to occur. In older individuals, the ischemic threshold can be easily reached with immediate clinical consequences.The results of treatment in the past have been less favorable in older than in younger patients 23,34 . Mc Kissock et Al 23 reported an operative mortality rate of 44% for patients between 60 and 70 years old and Martindale et Al 22 suggested that no patients older tha...