Surgical outcomes in elderly patients with aneurysmal subarachnoid hemorrhage

The optimum management for elderly patients with aneurysmal subarachnoid hemorrhage (SAH) remains controversial. The surgical indications for aneurysmal SAH in elderly patients were investigated. Materials and methods: This study retrospectively reviewed 148 elderly patients over 70 years old among 1019 patients surgically treated for SAH. The patients were divided into three groups: group A, 93 patients aged 70-74 years; group B, 33 patients aged 75-79 years; and group C, 22 patients aged over 80 years. The outcomes were evaluated using the Glasgow Outcome Scale, with good recovery and moderate disability considered as favorable. The surgical outcome was analyzed compared with the preoperative Hunt and Kosnik grade, location of the aneurysm and causes of complication. Results: A favorable outcome for patients in preoperative Hunt and Kosnik grades I and II was achieved in 84.8% of group A, 63.8% of group B and 57.1 % of group C, and for patients in grades III-V, 40.4% of group A, 15.4% of group B and 12.5% of group C. The rate of favorable outcome decreased with age and worse preoperative clinical grade. In patients remaining conscious before operation, the differences in recovery rates were not statistically significant by advancing age. For those patients with disturbance of consciousness, however, the recovery rate was significantly worse in groups B and C as compared with group A. The causes of poor outcome were primary brain damage, vasospasm and muscle weakness due to extended bed rest. In addition, more than half of the patients in a severely disabled or vegetative state at the time of discharge resulted in death within 5 years. Conclusion: Surgery should be considered for elderly patients with aneurysmal SAH leading a normal life before onset and without severe systemic disease, even in those over 80 years, but not in patients with disturbance of consciousness due to primary brain damage. (C) 2003 Elsevier B.V. All rights reserved.