Neuroradiology

, Volume 47, Issue 3, pp 215–221

Treatment and outcome of aneurysmal subarachnoid haemorrhage in the elderly patient

  • Veit Braun
  • Stefan Rath
  • Gregor Antoniadis
  • Hans-Peter Richter
  • Wolfgang Börm
Interventional Neuroradiology

Abstract

From January 1999 to May 2003, 316 aneurysms were treated, among them 40 patients (12.7%) over 65 years with subarachnoid haemorrhage (SAH). The results of this sub-group are presented. Mean age was 71 years (range 65–83 years), 40% of the patients were in (Hunt & Hess) grade I–III and 60% grade IV–V. Eighty-five percent of the aneurysms were located in the anterior circulation (35% ACom aneurysms). Nineteen aneurysms were coiled (all basilar tip and small-based ACom aneurysms), two among them subsequently clipped after coil compaction, 18 were initially clipped (most of MCA and all broad-based ACom aneurysms), two wrapped and one trapped. A total of 66.7% of the patients with coiled and 60.0% with clipped aneurysms had been hospitalized in poor condition (Hunt & Hess IV–V). The average follow-up period was 16 months. Overall, 35% of patients fully recovered, 5% returned to normal activity with some deficit, 33% remained dependent and 27% died. All seven patients with MCA aneurysms and intracerebral haematoma were clipped, but died or remained vegetative. Ten of 17 coiled patients (58.8%) had a favourable outcome, compared to 4/11 (36.4%) in the clip group, but two primarily coiled aneurysms rebleld due to coil compaction. The outcome is dependent on the primary Hunt & Hess grade. A total of 48.5% of SAH patients without intracerebral bleeding fully recovered, even patients in poor primary grade. Additional intracerebral haemorrhage is linked to a bad outcome. As primary procedure, the less traumatic coiling seems to be superior to clipping primarily. Better Hunt & Hess grades have a statistically significant chance for a promising outcome.

Keywords

Aneurysmal bleeding Clipping Coiling Elderly patient Geriatrics SAH 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Veit Braun
    • 1
  • Stefan Rath
    • 3
  • Gregor Antoniadis
    • 2
  • Hans-Peter Richter
    • 2
  • Wolfgang Börm
    • 2
  1. 1.Department of NeurosurgeryEvangelisches Jung-Stilling Krankenhaus SiegenSiegenGermany
  2. 2.Department of NeurosurgeryUniversity of UlmUlmGermany
  3. 3.Department of NeurosurgeryKlinikum DeggendorfDeggendorfGermany

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