Skip to main content
SpringerLink
Log in

Critical age affecting 1-year functional outcome in elderly patients aged ≥ 70 years with aneurysmal subarachnoid hemorrhage

  • Clinical Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

While advanced age is already recognized as an independent risk factor for a poor functional outcome following an aneurysmal subarachnoid hemorrhage (SAH), it is also important to investigate the critical age for defining a higher risk population among elderly patients and the clinical grade at admission in order to provide a prognostic description and help guide the management of patients aged ≥ 70 years.

Methods

This retrospective study included 165 patients aged 70–90 years who underwent surgical or endovascular treatment for a ruptured aneurysm. In addition to medical and radiological data, telephone interviews were used to obtain the 1-year functional outcome.

Results

A multivariate analysis revealed age (p = 0.001) and the World Federation of Neurological Surgeons (WFNS) grade (p = 0.001), regardless of the treatment modalities (surgical versus endovascular), as significant risk factors for a poor outcome, while a receiver operating characteristic analysis revealed 75 years as an appropriate cutoff value for the patient age to predict a poor 1-year functional outcome (area under the curve: 0.683). For the patients aged 70-75 years with good (1-3) and poor (4-5) WFNS grades, 81.9 % and 42.9 % achieved a favorable outcome (modified Rankin Scale 0-3), respectively, whereas for the patients over the critical age (> 75 years) with good and poor WFNS grades, 54.8 % and 5.9 % achieved a favorable outcome, respectively.

Conclusions

The long-term outcome for elderly patients with an aneurysmal SAH is affected primarily by the clinical condition at admission and the patient's age in relation to the critical age (> 75 years), regardless of the treatment modalities, including surgical clipping and endovascular coiling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Awe OO, Gonzalez LF, Hasan D, Maltenfort M, Rossenwasser R, Jabbour P (2011) Treatment outcome of aneurysmal subarachnoid hemorrhage in patients aged 70 years and older. Neurosurgery 68:753–758

    Article  PubMed  Google Scholar 

  2. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE Jr, Harbaugh RE, Patel AB, Rosenwasser RH, American Heart Association (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40:994–1025

    Article  PubMed  Google Scholar 

  3. Bradac GB, Bergui M, Fontanella M (2005) Endovascular treatment of cerebral aneurysms in elderly patients. Neuroradiology 47:938–941

    Article  CAS  PubMed  Google Scholar 

  4. Bruno A, Akinwuntan AE, Lin C, Close B, Davis K, Baute V, Aryal T, Brooks D, Hess DC, Switzer JA, Nichols FT (2011) Simplified modified rankin scale questionnaire: reproducibility over the telephone and validation with quality of life. Stroke 42:2276–2279

    Article  PubMed  Google Scholar 

  5. Cai Y, Spelle L, Wang H, Piotin M, Mounayer C, Vanzin JR, Moret J (2005) Endovascular treatment of intracranial aneurysms in the elderly: single-center experience in 63 consecutive patients. Neurosurgery 57:1096–1102

    Article  PubMed  Google Scholar 

  6. Chung RY, Carter BS, Norbash A, Budzik R, Putnam C, Ogilvy CS (2000) Management outcomes for ruptured and unruptured aneurysms in the elderly. Neurosurgery 47:827–833

    Article  CAS  PubMed  Google Scholar 

  7. Dorai Z, Hynan LS, Kopitnik TA, Samson D (2003) Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 52:763–769

    Article  PubMed  Google Scholar 

  8. Ferch R, Pasqualin A, Barone G, Pinna G, Bricolo A (2003) Surgical management of ruptured aneurysms in the eighth and ninth decades. Acta Neurochir (Wien) 145:439–445

    CAS  Google Scholar 

  9. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, MacDonald RL, Mayer SA (2006) Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 59:21–27

    Article  PubMed  Google Scholar 

  10. Fridriksson SM, Hillman J, Säveland H, Brandt L (1995) Intracranial aneurysm surgery in the 8th and 9th decades of life: impact on population-based management outcome. Neurosurgery 37:627–632

    Article  CAS  PubMed  Google Scholar 

  11. Gizewski ER, Göricke S, Wolf A, Schoch B, Stolke D, Forsting M, Wanke I (2008) Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes. AJNR Am J Neuroradiol 29:1575–1580

    Article  CAS  PubMed  Google Scholar 

  12. Horiuchi T, Tanaka Y, Hongo K (2005) Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery 56:469–475

    Article  PubMed  Google Scholar 

  13. Inagawa T (1993) Management outcome in the elderly patient following subarachnoid hemorrhage. J Neurosurg 78:554–561

    Article  CAS  PubMed  Google Scholar 

  14. Johansson M, Norbäck O, Gál G, Cesarini KG, Tovi M, Solander S, Contant CF, Ronne-Engström E, Enblad P (2004) Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage. Neuroradiology 46:385–391

    Article  CAS  PubMed  Google Scholar 

  15. Karamanakos PN, Koivisto T, Vanninen R, Khallaf M, Ronkainen A, Parviainen I, Manninen H, von und zu Fraunberg M, Morgan MK, Jaaskelainen JE, Hernesniemi J, Rinne J (2010) The impact of endovascular management on the outcome of aneurysmal subarachnoid hemorrhage in the elderly in eastern Finland. Acta Neurochir (Wien) 152:1493–1502

    Article  Google Scholar 

  16. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL (1990) The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 73:18–36

    Article  CAS  PubMed  Google Scholar 

  17. Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, Jane JA (1996) Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 85:410–418

    Article  CAS  PubMed  Google Scholar 

  18. Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP (2004) Endovascular treatment of ruptured intracranial aneurysms in elderly people. AJNR Am J Neuroradiol 25:592–595

    PubMed  Google Scholar 

  19. Mocco J, Ransom ER, Komotar RJ, Schmidt JM, Sciacca RR, Mayer SA, Connolly ES Jr (2006) Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery 59:529–538

    Article  CAS  PubMed  Google Scholar 

  20. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267–1274

    Article  PubMed  Google Scholar 

  21. Nieuwkamp DJ, Rinkel GJ, Silva R, Greebe P, Schokking DA, Ferro JM (2006) Subarachnoid haemorrhage in patients ≥75 years: clinical course, treatment and outcome. J Neurol Neurosurg Psychiatry 77:933–937

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Park J (2011) Saccular aneurysm with basal rupture angiographically depicted as an aneurysm with stalk-like narrow neck. J Neurosurg 114:1065–1068

    Article  PubMed  Google Scholar 

  23. Park J, Woo H, Kang DH, Kim Y, Baik SK (2012) Ruptured intracranial aneurysms with small Basal outpouching: incidence of Basal rupture and results of surgical and endovascular treatments. Neurosurgery 71:994–1002

    Article  PubMed  Google Scholar 

  24. Proust F, Gérardin E, Derrey S, Lesvèque S, Ramos S, Langlois O, Tollard E, Bénichou J, Chassagne P, Clavier E, Fréger P (2010) Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients. J Neurosurg 112:1200–1207

    Article  PubMed  Google Scholar 

  25. Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ (2008) International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke 39:2720–2726

    Article  PubMed  Google Scholar 

  26. Ryttlefors M, Howells T, Ronne-Engström E, Nilsson P, Enblad P (2010) Neurointensive care is justified in elderly patients with severe subarachnoid hemorrhage–an outcome and secondary insults study. Acta Neurochir (Wien) 152:241–249

    Article  Google Scholar 

  27. Sedat J, Dib M, Lonjon M, Litrico S, Von Langsdorf D, Fontaine D, Paquis P (2002) Endovascular treatment of ruptured intracranial aneurysms in patients aged 65 years and older: follow-up of 52 patients after 1 year. Stroke 33:2620–2625

    Article  CAS  PubMed  Google Scholar 

  28. Wachter D, Hans F, Kreitschmann-Andermahr I, Rohde V (2011) Lower incidence of transcranial Doppler and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and aneurysm clipping in the elderly patient? Neurosurgery 69:261–267

    Article  PubMed  Google Scholar 

  29. Yamashita K, Kashiwagi S, Kato S, Takasago T, Ito H (1997) Cerebral aneurysms in the elderly in Yamaguchi, Japan. Analysis of the Yamaguchi Data Bank of Cerebral Aneurysm from 1985 to 1995. Stroke 28:1926–1931

    Article  CAS  PubMed  Google Scholar 

  30. Yoshimoto Y, Kwak S (1995) Age-related multifactorial causes of neurological deterioration after early surgery for aneurysmal subarachnoid hemorrhage. J Neurosurg 83:984–988

    Article  CAS  PubMed  Google Scholar 

Download references

DISCLOSURE

This study was supported by a grant from the Korea Healthcare Technology R & D Project, Ministry of Health & Welfare (A100870), Republic of Korea.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea

    Jaechan Park & Hyunjin Woo

  2. Department of Radiology, Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea

    Dong-Hun Kang & Yongsun Kim

  3. Department of Neurosurgery, Kyungpook National University Hospital, 50, Samduk 2-Ga, Jung-Gu, Daegu, 700-721, Republic of Korea

    Jaechan Park

Authors
  1. Jaechan Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyunjin Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong-Hun Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yongsun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jaechan Park.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, J., Woo, H., Kang, DH. et al. Critical age affecting 1-year functional outcome in elderly patients aged ≥ 70 years with aneurysmal subarachnoid hemorrhage. Acta Neurochir 156, 1655–1661 (2014). https://doi.org/10.1007/s00701-014-2133-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-014-2133-6

Keywords

Search

Navigation