Abstract
Purpose: We focused on the recent management of aneurysmal subarachnoid hemorrhage (SAH) in patients over 70 years old (advanced age).
Methods: From January 2001 through July 2009 we treated 372 aneurysmal SAH cases including 123 patients of advanced age. Since 2006 we have been selecting primarily interventional treatment in advanced age. We divided patients into two groups: from 2001 to 2005 and from 2006 to 2009. We analyzed Hunt-Kosnik (HK) grade, treatment methods, rate of vasospasm, Glasgow Outcome Scale at 30 days after onset of SAH, and the ratio of shunt operations. Statistical analyses were done with chi-square analysis or the t-test.
Results: The ratio of procedures in advanced age increased statistically from 28% (51/183) to 38% (72/189). Mean age of patients increased from 76.2 to 77.7. HK grade and proportion of radical surgeries were similar. But the proportion of acute stage surgery and coil embolization increased significantly from 79 to 95% and from 8 to 24%, respectively. Incidence of symptomatic vasospasm increased from 35 to 37%, while asymptomatic vasospasm decreased from 4.7 to 3.2%. Rate of angioplasty increased significantly from 22 to 76%. The proportion of shunt surgeries decreased from 33 to 19% and favorable outcomes increased from 47 to 51%.
Conclusions: Mean age and proportion of procedures in advanced age are increasing, but outcomes have improved. These results depend on radical surgery for aneurysm in the acute stage and aggressive prevention and treatment of vasospasm. Interventional treatment is necessary to improve the outcome in cases of advanced age.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Asano S, Hara T, Haisa T, Okamoto K, Kato T, Ohno H, et al. Outcomes of 24 patients with subarachnoid hemorrhage aged 80 years or older in a single center. Clin Neurol Neurosurg. 2007;109:853–857.
Braun V, Rath S, Antoniadis G, Richter HP, Borm W. Treatment and outcome of aneurysmal subarachnoid haemorrhage in the elderly patient. Neuroradiology 2005;47:215–221
Gizewski ER, Goricke S, Wolf A, Schoch B, Stolke D, Forsting M, et al. Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes. Am J Neuroradiol. 2008;29:1575–1580.
Iwabuchi S, Yokouchi T, Hayashi M, Uehara H, Ueda M, Samejima H. Intra-arterial administration of fasudil hydrochloride for vasospasm following subarachnoid hemorrhage – analysis of time-density curve with digital subtraction angiography. Neurol Med Chir (Tokyo). 2006;46:535–539.
Johansson M, Norback O, Gal G, Cesarini KG, Tovi M, Solander S, et al. Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage. Neuroradiology. 2004;46:385–391.
Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP, Pruvo JP. Endovascular treatment of ruptured intracranial aneurysms in elderly people. Am J Neuroradiol. 2004;25:592–5.
Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267–1274.
Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809–817.
Munakata A, Ohkuma H, Nakano T, Shimamura N, Asano K, Naraoka M. Effect of a free radical scavenger, edaravone, in the treatment of patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2009;64:423–428.
Natarajan SK, Sekhar LN, Ghodke B, Britz GW, Bhagawati D, Temkin N. Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center. Am J Neuroradiol. 2008;29:753–759.
Nieuwkamp DJ, Rinkel GJ, Silva R, Greebe P, Schokking DA, Ferro JM. Subarachnoid haemorrhage in patients > or = 75 years: clinical course, treatment and outcome. J Neurol Neurosurg Psychiatry. 2006;77:933–937.
Pinsker MO, Gerstner W, Wolf S, Trost HA, Lumenta CB. Surgery and outcome for aneurysmal subarachnoid hemorrhage in elderly patients. Acta Neurochir Suppl. 2002;82:61–64.
Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007;38:2315–2321.
Ryttlefors M, Enblad P, Kerr RS, Molyneux AJ. International subarachnoid aneurysm trial of neurosurgical clipping versus endovascular coiling: subgroup analysis of 278 elderly patients. Stroke 2008;39:2720–2726.
Shimamura N, Naraoka M, Nakano T, Ogasawara Y, Takeda T, Ohkuma H. Role of coil embolization and arterial injection in elderly subarachnoid hemorrhage patients: preliminary report. No Shinkei Geka. 2008;36:873–878.
Acknowledgement
This study was supported by a Hirosaki University Grant for Exploratory Research by Young Scientists to NS.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this paper
Cite this paper
Shimamura, N., Munakata, A., Ohkuma, H. (2011). Current Management of Subarachnoid Hemorrhage in Advanced Age. In: Feng, H., Mao, Y., Zhang, J.H. (eds) Early Brain Injury or Cerebral Vasospasm. Acta Neurochirurgica Supplements, vol 110/2. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0356-2_27
Download citation
DOI: https://doi.org/10.1007/978-3-7091-0356-2_27
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-0355-5
Online ISBN: 978-3-7091-0356-2
eBook Packages: MedicineMedicine (R0)