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Ewbank F, Hall S, Gaastra B, Fisher B, Coe L, Booker J, Kaldas A, Anderson I, Critchley G, Teo M, Toma A, Trivedi R, Uff C, Vindlacheruvu R, Dulhanty L, Javadpour M, Walsh D, Galea J, Patel H, Bulters D. Aneurysm management in patients over 80 years old with good grade subarachnoid haemorrhage. Br J Neurosurg 2023:1-7. [PMID: 37147868 DOI: 10.1080/02688697.2023.2205939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND An increasing proportion of aneurysmal subarachnoid haemorrhage (aSAH) occurs in older patients, in whom there is widespread variability in treatment rates due to a different balance of risks. Our aim was to compare outcomes of patients over 80 years old with good grade aSAH who underwent treatment of their aneurysm with those who did not. METHODS Adult patients with good grade aSAH admitted to tertiary regional neurosciences centres contributing to the UK and Ireland Subarachnoid Haemorrhage Database (UKISAH) and a cohort of consecutive patients admitted from three regional cohorts were included for analysis. Outcomes were functional outcome at discharge, three months and survival at discharge. RESULTS In the UKISAH, patients whose aneurysm was treated were more likely to have a favourable outcome at discharge (OR 2.34, CI 1.12-4.91, p = .02), at three months (OR 2.29, CI 1.11-4.76, p = .04), and lower mortality (10% vs. 29%, OR 0.83, CI 0.72-0.94, p < .01). In the regional cohort, a similar pattern was seen, but after correction for frailty and comorbidity there was no difference in survival (HR 0.45, CI 0.12-1.68, p = .24) or favourable outcome at discharge (OR 0.83, CI 0.23-2.94, p = .77) and at three months (OR 1.03, CI 0.25-4.29, p = .99). CONCLUSIONS Better early functional outcomes in those undergoing aneurysm treatment appear to be explained by differences in frailty and comorbidity. Therefore, treatment decisions in this patient group are finely balanced with no clear evidence overall of either benefit or harm in this cohort.
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Affiliation(s)
- Frederick Ewbank
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Benjamin Gaastra
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Benjamin Fisher
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Laura Coe
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - James Booker
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Antony Kaldas
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
| | - Ian Anderson
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - Giles Critchley
- Department of Neurosurgery, University Hospitals Sussex, Brighton, UK
| | - Mario Teo
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, North Bristol NHS Trust, Bristol, UK
| | - Ahmed Toma
- Department of Neurosurgery, University College London Hospitals, London, UK
| | - Rikin Trivedi
- Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK
| | - Chris Uff
- Department of Neurosurgery, Barts Health NHS Trust, London, UK
| | - Raghu Vindlacheruvu
- Department of Neurosurgery, Barking, Havering and Redbridge University Hospitals, Romford, UK
| | - Louise Dulhanty
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK
| | | | - Daniel Walsh
- Department of Neurosurgery, King's College Hospital, London, UK
| | - James Galea
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, UK
| | - Hiren Patel
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK
| | - Diederik Bulters
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
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WAKUTA N, FUKUDA K, TAKAHARA M, YAMAMOTO S, ARIMA H, MOTONAGA E, INOUE T. Epidemiology of Subarachnoid Hemorrhage in Isolated Islands in Japan: A Population-based Study in the Miyako Islands. Neurol Med Chir (Tokyo) 2022; 63:23-30. [PMID: 36436978 PMCID: PMC9894620 DOI: 10.2176/jns-nmc.2022-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Miyako Islands (with a population of approximately 50,000) are located in southwestern Japan, with a subtropical oceanic climate. This isolated location permitted a retrospective population-based epidemiological study of subarachnoid hemorrhage. We retrospectively enrolled 110 consecutive patients from 2010 to 2019 using the subarachnoid hemorrhage database at Okinawa Miyako Hospital, which is the only local facility with neurosurgeons. We calculated the incidence of subarachnoid hemorrhage standardized to the entire Japanese population. The seasonal distribution of subarachnoid hemorrhage onset and patients' epidemiological characteristics were also investigated. The standardized annual incidence of subarachnoid hemorrhage was 21.4 per 100,000 population, as reported previously in Japan. The patients' mean age was 62.1 ± 15.4 years, and women constituted 60.9%. Anterior communicating artery aneurysms were most common. The endovascular treatment for ruptured aneurysms was increasing as standard levels in Japan. The rates of symptomatic vasospasm and secondary hydrocephalus requiring additional neurosurgical treatment were 2.7% and 19.1%, respectively. The mortality rate was 23.6%. The percentage of patients with a modified Rankin scale score of 0-2 at discharge was 55.5%. There were no differences in the frequency of subarachnoid hemorrhage associated with seasonal distribution or climatic factors. The incidence, baseline characteristics, and clinical outcomes of subarachnoid hemorrhage in the Miyako Islands were similar to those in other regions of Japan. There are preferable epidemiological backgrounds for further practical clinical research.
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Affiliation(s)
- Naoki WAKUTA
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan,Department of Neurosurgery, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Kenji FUKUDA
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan,Department of Neurosurgery, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Masaki TAKAHARA
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan,Department of Neurosurgery, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Satoshi YAMAMOTO
- Department of Neurosurgery, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Hisatomi ARIMA
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Eiji MOTONAGA
- Department of Rehabilitation, Internal Medicine, and Family Medicine, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan
| | - Tooru INOUE
- Department of Neurosurgery, Fukuoka University Hospital, and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
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Lee SW, Kwon HJ, Jeong EO, Koh HS, Kim KH, Choi SW, Kim SH, Youm JY. Endovascular coil embolization for unruptured intracranial aneurysms in patients over 80 years of age. J Cerebrovasc Endovasc Neurosurg 2020; 22:237-244. [PMID: 33050684 PMCID: PMC7820267 DOI: 10.7461/jcen.2020.e2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022] Open
Abstract
Objective As the average life span in modern society continues to increase, much interest is focused on high-risk procedures in elderly patients, including major surgical operations. We investigated the results of endovascular coiling of unruptured intracranial aneurysms (UIA) in patients over 80 years of age. Methods We retrospectively analyzed 39 patients aged over 80 years who underwent coil embolization for UIA between April 2007 and April 2019 at our hospital. Results Complete occlusion on digital subtraction angiography (DSA) immediately after surgery was performed in 44 (84.6%) of 52 cases of cerebral aneurysms. Four patients (7.7%) had residual aneurysmal necks, and four (7.7%) had contrast flow in the aneurysmal sac. Follow-up magnetic resonance angiography (mean: 8.2 months) was performed in 37 aneurysms in 24 patients. There was evidence of blood flow in the neck in seven cases (18.9%) and aneurysm in two cases (5.4%). Follow-up DSA (mean: 20.5 months) was performed in 14 aneurysms in 11 patients, and 11 aneurysms (78.6%) had complete occlusion, 1 aneurysm (7.1%) had an aneurysmal neck, and 2 aneurysms (14.3%) had contrast filling into the aneurysmal sac. Coil embolization procedure-related complications occurred in 3 patients (7.7%). Cerebral infarction occurred in 1 (2.6%), arterial dissection in 1 (2.6%), and hypoesthesia in 1 (2.6%). Conclusions Active treatment of UIA in elderly patients over 80 years of age through endovascular coil embolization can be considered.
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Affiliation(s)
- Seok-Won Lee
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea.,Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Eun-Oh Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Hyeon-Song Koh
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea.,Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea.,Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Seon-Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea.,Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea.,Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
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Katsuki M, Yamamoto Y, Uchiyama T, Wada N, Kakizawa Y. Clinical characteristics of aneurysmal subarachnoid hemorrhage in the elderly over 75; would temporal muscle be a potential prognostic factor as an indicator of sarcopenia? Clin Neurol Neurosurg 2019; 186:105535. [PMID: 31569058 DOI: 10.1016/j.clineuro.2019.105535] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Age of patients with subarachnoid hemorrhage (SAH) is increasing. It is challenging to decide whether to perform aneurysm treatment and to predict their prognosis. We assumed that elderly patients with SAH who do not suffer from sarcopenia tend to have good outcomes. Temporal muscle thickness (TMT) and area (TMA) are useful indicators of sarcopenia. We investigated the clinical characteristics, including temporal muscle, in SAH patients over 75 years old. PATIENTS AND METHODS We retrospectively analyzed 49 SAH patients over 75 years old from 2014 to 2018, who accounted for 37% of the patients in all age group. The correlations between the clinical variables and the modified Rankin Scale (mRS) at discharge were analyzed. RESULTS Of the all 49 SAH patients over 75 years old, premorbid mRS, WFNS grade, lymphocyte, aneurysm size, TMT, TMA, showed significant correlations with mRS at discharge. Men and the absence of hydrocephalus were correlated with favorable outcomes. Thirteen of the 24 patients over 75 years old whose WFNS grade were I to III but also who underwent aneurysm treatment had favorable outcomes (mRS 0-2), and their standardized TMT divided by height, by weight, and TMA divided by weight were significantly larger than that with poor outcomes. CONCLUSION Aneurysm intervention should be considered when patients over 75 years old do not suffer from sarcopenia. Temporal muscle would indicate premorbid mRS and be potentially useful to decide surgical indication and to predict outcome after aneurysm treatment in the elderly.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Toshiya Uchiyama
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Naomichi Wada
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Suwa Red Cross Hospital, Suwa, Nagano, Japan.
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5
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Cheikh A, Kasinathan S, Yasuhiro Y, Kawase T, Kato Y. Surgical Management of Unruptured Cerebral Aneurysms in the Elderly: An Institution Experience. Asian J Neurosurg 2019; 14:730-736. [PMID: 31497093 PMCID: PMC6703043 DOI: 10.4103/ajns.ajns_233_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: The elderly population is increasing in the world, especially in developed countries. The gain in life expectancy is remarkable in Japan, consequently incidence of aneurysms increases in this population. The purpose of this study is to evaluate the surgical treatment and outcome of patients aged more than 75 years treated for unruptured intracranial aneurysms. Patients and Methods: We conducted a retrospective study for unruptured cerebral aneurysms operated between September 2014 and August 31, 2018, in Fujita Health University, Banbuntane Hotokukai Hospital, for people aged more than 75 years. A demographic study was done. We also studied aneurysm location, aneurysm size, outcome, duration of stay, and complications. Results: About 61 patients aged more than 75 years were operated in 4 years, comprising 12 males and 45 females. The mean age was 79.32 ± 3.29 years. Mean size of the aneurysm was 6.22 ± 3.28. Aneurysm location (P = 0.0037), associated risk factors (P = 0.006), and association of hypertension and diabetes (P = 0.0362) influence outcome. Length of stay is directly correlated with outcome (P = 0.009). Conclusions: Elder patients with hypertension and diabetes or associated risk factors having a posterior circulation aneurysm have a poor diagnosis.
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Affiliation(s)
- Abderrahmane Cheikh
- Department of Neurosurgery, Ali Ait Idir Hospital and Medical School of Algiers - Algiers University 1, Algiers, Algeria
| | - Sudhakar Kasinathan
- Department of Neurosurgery, Institute of Neurosurgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Yamada Yasuhiro
- Department of Neurosurgery, Banbutane Hotkukai Hospital, Fujita Health University, Toyoake, Nagoya, Aichi Prefecture, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Banbutane Hotkukai Hospital, Fujita Health University, Toyoake, Nagoya, Aichi Prefecture, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbutane Hotkukai Hospital, Fujita Health University, Toyoake, Nagoya, Aichi Prefecture, Japan
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Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, Kato Y, Azevedo-Filho H, Morcos JJ, Park KB. Estimating the Global Incidence of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review for Central Nervous System Vascular Lesions and Meta-Analysis of Ruptured Aneurysms. World Neurosurg 2018; 115:430-447.e7. [DOI: 10.1016/j.wneu.2018.03.220] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 11/16/2022]
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7
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Comparison of Aggressive Surgical Treatment and Palliative Treatment in Elderly Patients with Poor-Grade Intracranial Aneurysmal Subarachnoid Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5818937. [PMID: 29998135 PMCID: PMC5994574 DOI: 10.1155/2018/5818937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/19/2018] [Indexed: 12/29/2022]
Abstract
Objective To compare the current treatment approach in elderly patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) and identify the independent predictors of the outcome after aggressive surgical treatment. Method This prospective, multicenter cohort study included 104 poor-grade aneurysmal SAH elderly patients, 60 years or older, treated in our institution from October 2010 to March 2013. Patients were grouped according to three treatment arms. Neurological outcome was assessed using the Glasgow Outcome Scale (GOS) at baseline and at a 12-month follow-up. Univariate and multivariate analysis were performed using the following factors: sex, age, smoking history, breathing ability, alcohol consumption, cerebral hernia, aneurysm location, aneurysm diameter, WFNS grade, CT Fisher grade, treatment approach, and the timing of the aneurysm surgery. Results At the 12-month follow-up, patients in the coiling group and clipping group had better prognosis than patients in the palliative treatment group. Univariate analysis confirmed that the treatment approach, WFNS grade, CT Fisher grade, and age are critical factors for neurological outcomes in poor-grade SAH. Multivariate analysis indicated that WFNS grade V, CT Fisher grades 3-5, and palliative treatment were independent predictors of poor prognoses. Conclusion Aggressive surgical treatment improves the prognoses in poor-grade aneurysm elderly patients with SAH. Elderly Patients of WFNS grade IV and CT Fisher grades 1-2 are more likely to have a better outcome.
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8
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Ohkuma H, Shimamura N, Naraoka M, Katagai T. Aneurysmal Subarachnoid Hemorrhage in the Elderly over Age 75: A Systematic Review. Neurol Med Chir (Tokyo) 2017; 57:575-583. [PMID: 28835583 PMCID: PMC5709710 DOI: 10.2176/nmc.ra.2017-0057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The number of elderly patients with an aneurysmal subarachnoid hemorrhage (aSAH) has been increasing in aging- or aged societies in many countries. A treatment strategy for the elderly with aSAH has not been established, although many studies have been published emphasizing poor outcome for aSAH. The aim of this study was to analyze the factors and treatments affecting outcome in aSAH in the elderly in a systematic review of the literature by investigating patients over age 75. A literature search was done for “elderly aSAH” in PubMed and Embase. Literature with a clear description of treatment measures for aneurysmal occlusion and outcome was selected. Twelve studies, consisted of 816 cases, met the eligibility criteria. Patient characteristics included 83.2% female, 33.8% poor clinical grade on admission, 57.1% Fischer group 3, and 41% internal carotid artery aneurysm. As complications, symptomatic vasospasm was seen in 25.5% of patients, hydrocephalus in 31.1%, and medical complication in 38.4%. Favorable outcome was 35.0% in total, 45.3% for clipping, 36.3% for coiling, and 9.0% for conservative treatment. Several studies by multivariate analysis indicated that poor clinical grade on admission could be a risk factor for neurological outcome and mortality. Advanced age and selection of conservative treatment without aneurysmal occlusion could be a risk factor for mortality. Patients under age 85 with good clinical grade on admission can be candidates for treatment of aneurysm repair. However, treatment for patients over age 85 or with poor clinical grade should be carefully determined.
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González-Bonet LG, Tarazona-Santabalbina FJ, Lizán Tudela L. Neurocirugía en el paciente mayor: neurocirugía geriátrica. Neurocirugia (Astur) 2016; 27:155-66. [DOI: 10.1016/j.neucir.2015.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/15/2015] [Accepted: 11/03/2015] [Indexed: 01/18/2023]
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10
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McCutcheon BA, Kerezoudis P, Porter AL, Rinaldo L, Murphy M, Maloney P, Shepherd D, Hirshman BR, Carter BS, Lanzino G, Bydon M, Meyer F. Coma and Stroke Following Surgical Treatment of Unruptured Intracranial Aneurysm: An American College of Surgeons National Surgical Quality Improvement Program Study. World Neurosurg 2016; 91:272-8. [PMID: 27108027 DOI: 10.1016/j.wneu.2016.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. METHODS The American College of Surgeons National Surgical Quality Improvement Program data set between 2007 and 2013 was used for this retrospective cohort analysis. Demographic, comorbidity, and operative characteristics associated with the development of a major neurologic complication (i.e., coma or stroke) were elucidated using a backward selection stepwise logistic regression analysis. This model was subsequently used to fit a predictive score for major neurologic complications. RESULTS Inclusion criteria were met by 662 patients. Of these patients, 57 (8.61%) developed a major neurologic complication (i.e., coma or stroke) within the 30-day postoperative period. On multivariable analysis, operative time (log odds 0.004 per minute; 95% confidence interval [CI], 0.002-0.007), age (log odds 0.05 per year; 95% CI, 0.02-0.08), history of chronic obstructive pulmonary disease (log odds 1.26; 95% CI, 0.43-2.08), and diabetes (log odds 1.15; 95% CI, 0.38-1.91) were associated with an increased odds of major neurologic complications. When patients were categorized according to quartile of a predictive score generated from the multivariable analysis, rates of major neurologic complications were 1.8%, 4.3%, 6.7%, and 21.2%. CONCLUSIONS Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
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Affiliation(s)
- Brandon A McCutcheon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Panagiotis Kerezoudis
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda L Porter
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan Murphy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick Maloney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Shepherd
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
| | - Fredric Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Park JH, Kim YI, Lim YC. Clinical outcomes of treatment for intracranial aneurysm in elderly patients. J Cerebrovasc Endovasc Neurosurg 2014; 16:193-9. [PMID: 25340020 PMCID: PMC4205244 DOI: 10.7461/jcen.2014.16.3.193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/28/2014] [Accepted: 08/11/2014] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of this study is to evaluate the clinical course of intracranial aneurysm in patients aged 65 years and older and the immediate outcome after its aggressive management. Materials and Methods We performed a retrospective analysis using the medical records of 159 elderly patients managed at our institute from September 2008 to December 2013. Obtained clinical information included age, sex, Hunt and Hess grade (HHG), aneurysm location, Fisher grade (FG) and the treatment modality. Concomitant clinical data aside from cerebrovascular condition (hypertension, diabetes, previous medication) were evaluated to determine risk factors that might affect the functional outcomes. Results A total of 108 patients (67.9%) presented with subarachnoid hemorrhage (SAH), and 51 (32.1%) with unruptured intracranial aneurysms (UIAs). Coiling was performed in 101 patients and 58 patients underwent clipping. In the SAH population, 62 patients (57.4%) showed favorable outcomes, with a mortality rate of 11.3% (n = 18). In the UIAs population, 50 (98%) patients achieved 'excellent' and one (2%) achieved 'good' outcome. Factors including high-grade HHG (p < 0.001), advanced age (p = 0.014), and the presence of intraventricular hematoma (IVH) (p = 0.017) were significant predictors of poor outcome. Conclusion SAH patients with high grade HHG and IVH are associated with poor outcome with statistical significance, all the more prominent the older the patient is. Therefore, the indication for aggressive therapy should be considered more carefully in these patients. However, as the outcomes for elderly patients with UIAs were excellent regardless of the treatment modality, aggressive treatment could always be considered in UIAs cases.
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Affiliation(s)
- Jun Hee Park
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
| | - Young Im Kim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea
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12
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Park J, Woo H, Kang DH, Kim Y. Critical age affecting 1-year functional outcome in elderly patients aged ≥ 70 years with aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2014; 156:1655-61. [PMID: 24950994 DOI: 10.1007/s00701-014-2133-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 05/08/2014] [Indexed: 01/23/2023]
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.
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Affiliation(s)
- Jaechan Park
- Department of Neurosurgery Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea,
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Kubo Y, Koji T, Kashimura H, Otawara Y, Ogawa A, Ogasawara K. Female sex as a risk factor for the growth of asymptomatic unruptured cerebral saccular aneurysms in elderly patients. J Neurosurg 2014; 121:599-604. [DOI: 10.3171/2014.5.jns132048] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Object
The prevalence of patients with asymptomatic unruptured intracranial aneurysms (UIAs) increases with the advancing age of the general population. The goal of the present study was to identify risk factors for the growth of UIAs detected with serial MR angiography (MRA) in patients 70 years of age or older.
Methods
This prospective study enrolled 79 patients (age range 70–84 years) with 98 UIAs. Patients were followed up every 4 months, including an assessment of the aneurysm diameter and morphological changes on MRA, neurological status, and other medical conditions. Aneurysm growth was categorized into two different patterns on the basis of the MRA findings: 1) maximum increase in aneurysm diameter of 2 mm or more; and 2) obvious morphological change, such as the appearance of a bleb.
Results
The mean duration of follow-up was 38.5 months (250.2 patient-years). Aneurysm rupture did not occur, but aneurysm growth was observed in 8 aneurysms (8 patients) during the study period. Univariate analysis showed that female sex, patient age ≥ 75 years, and an aneurysm location in the internal carotid artery (ICA) or middle cerebral artery (MCA) were associated with aneurysm growth (p = 0.04, p = 0.04, and p < 0.001, respectively). Multivariate analysis demonstrated that female sex was the only independent predictor of aneurysm growth (p = 0.0313, OR 2.3, 95% CI 1.3–30.2).
Conclusions
Female sex is an independent risk factor for the growth of UIAs in elderly patients. In addition, an age ≥ 75 years and aneurysm location in the ICA or MCA are characteristics that may warrant additional attention during follow-up imaging.
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Watanabe D, Hashimoto T, Koyama S, Ohashi HT, Okada H, Ichimasu N, Kohno M. Endovascular treatment of ruptured intracranial aneurysms in patients 70 years of age and older. Surg Neurol Int 2014; 5:104. [PMID: 25101199 PMCID: PMC4123254 DOI: 10.4103/2152-7806.136090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 05/08/2014] [Indexed: 11/22/2022] Open
Abstract
Background: An increasing number of elderly patients present with intracranial aneurysms. In addition to female gender, an older age is associated with a higher risk of developing a subarachnoid hemorrhage (SAH), and these patients often fare poorly in terms of long-term outcome. It is often thought that elderly patients would especially benefit from endovascular aneurysm treatment. We assessed the clinical outcomes in elderly patients with ruptured intracranial aneurysms (RIAs) who were treated by endovascular procedures. Methods: We performed a retrospective review of a prospective database of elderly patients treated with coil embolization for RIAs. The clinical outcomes were assessed using the modified Glasgow Outcome Scale. The rates of procedural complications and adverse events were also recorded. Results: During a period of 5 years, 162 patients with 183 intracranial aneurysms were treated in our hospital by means of an endovascular approach. Among them, 51 patients (31.5%) with a ruptured aneurysm were aged 70 years or older. These patients aged 70-91 years (mean age, 74 years) were treated by coil embolization for RIAs. Among them, seven had a Hunt and Hess (HH) grade of I or II, 42 had an HH grade of III or IV, and 2 had an HH grade of V. Endovascular treatment resulted in 32 complete occlusions (62.7%), 15 neck remnants (22%), and 4 body fillings (7.9%). Procedural complications occurred in five patients (9.8%). The outcomes were good or excellent in 17 patients (33.3%). Three patients (5.8%) who died had an HH grade of IV or V. Rebleeding occurred during follow-up in one patient (1.9%). Conclusions: Coil embolization of intracranial aneurysms is safe and effective in the elderly. However, the morbidity and mortality rates are higher in patients with high HH grades. This finding suggests that the timing of treatment should be based on the patient's initial clinical status.
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Affiliation(s)
- Daisuke Watanabe
- Department of Neurosurgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku ku, Tokyo 160-0023, Japan
| | - Takao Hashimoto
- Department of Neurosurgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku ku, Tokyo 160-0023, Japan
| | - Shunichi Koyama
- Department of Neurosurgery, Social Insurance Chuo General Hospital, 3-22-1 Hyakunintyo, Shinjuku-ku, Tokyo 169-0073, Japan
| | - H Tomoo Ohashi
- Department of Neurosurgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Amimachi Chuou, Inagi-gun, Ibaraki 300-0395, Japan
| | - Hirohumi Okada
- Department of Neurosurgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku ku, Tokyo 160-0023, Japan
| | - Norio Ichimasu
- Department of Neurosurgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku ku, Tokyo 160-0023, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku ku, Tokyo 160-0023, Japan
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Clip chirurgical, coil endovasculaire : comment choisir le traitement des anévrismes intracrâniens. Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Darsaut T, Kotowski M, Raymond J. How to choose clipping versus coiling in treating intracranial aneurysms. Neurochirurgie 2012; 58:61-75. [DOI: 10.1016/j.neuchi.2012.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
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Derrey S, Curey S, Hannequin P, Castel H, Langlois O, Tollard E, Fréger P, Proust F. Elderly patients with aneurysmal subarachnoid hemorrhage: Coils but also clips. Neurochirurgie 2012; 58:140-5. [PMID: 22464899 DOI: 10.1016/j.neuchi.2012.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 02/08/2012] [Indexed: 11/19/2022]
Abstract
The ageing of the population in good health or without severe morbidity expose them to the occurrence of a subarachnoid hemorrhage (SAH) and requires effective management. Currently, the pertinence of cerebral aneurysm treatment by clipping or coiling is accepted for patients in the 8th or 9th decade of life, and the risk of postoperative morbidity induced by our therapeutic alternative must be carefully assessed. In these decades, the female/male sex ratio for aneurysmal SAH was greater in female who had a 1.6 times higher ratio than in male. The initial clinical status did not appear worse with age despite the frequent severity of bleeding observed on CT scan probably due to the large subarachnoid space. The aneurysm distribution and size were similar to those classically reported in the global population. The endovascular (EV) coiling appears as the first option with a favorable outcome rate estimated at 48% to 63%. Nevertheless, the benefit of EV coiling compared to microsurgical clipping for treatment of ruptured aneurysm in the elderly has not been demonstrated in a large randomized study. This is the reason why the vascular section of the French Society of Neurosurgery developed a prospective and randomized study of the aneurysmal SAH (PHRC 2007-042/HP) on the elderly patients.
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Affiliation(s)
- S Derrey
- Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
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Hwang SK, Hwang G, Oh CW, Jin SC, Park H, Bang JS, Kwon OK. Endovascular treatment for unruptured intracranial aneurysms in elderly patients: single-center report. AJNR Am J Neuroradiol 2011; 32:1087-90. [PMID: 21596818 PMCID: PMC8013144 DOI: 10.3174/ajnr.a2458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 11/01/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The optimal management of patients with unruptured intracranial aneurysms remains controversial in elderly populations. The aim of this study was to evaluate technical results and clinical outcomes in a single center of consecutive elderly patients with unruptured intracranial aneurysms treated with endovascular embolization. MATERIALS AND METHODS Between May 2003 and February 2010, 96 patients older than 70 years (men, 16 patients; women, 80 patients; mean age, 73 years) with 122 saccular unruptured intracranial aneurysms were treated in our hospital with an endovascular approach. The endovascular procedures and technique, angiographic follow-up, and complications were evaluated. RESULTS Successful embolizations without complications were completed in 95.9%. Five patients had procedure-related events, including thromboembolism in 1 patient, aneurysm perforation during the procedure in 1, and 3 postoperative transient minor symptoms (headache, otalgia, and trigeminal pain) in 3. The degree of occlusion of the treated aneurysm was complete in 46.7%; there was a small neck remnant in 40.9% and residual filling in 12.2%. Imaging (MR angiography) follow-up was performed in 68.7% of the patients. The mean follow-up duration was 19.4 months (range, 5-57 months). Fifty-five patients (93.9%) showed no interval change of the residual neck. Four (6%) demonstrated recanalizations, all of which were successfully recoiled. CONCLUSIONS Endovascular treatment of unruptured intracranial aneurysms in patients older than 70 years of age appears to be safe. Favorable outcomes with low morbidities may replace surgery or conservative treatment as an active management alternative.
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Affiliation(s)
- S-K Hwang
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Seoul, Korea
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Jang EW, Jung JY, Hong CK, Joo JY. Benefits of surgical treatment for unruptured intracranial aneurysms in elderly patients. J Korean Neurosurg Soc 2011; 49:20-5. [PMID: 21494358 DOI: 10.3340/jkns.2011.49.1.20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/09/2010] [Accepted: 01/07/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affects the clinical outcomes and post-procedural morbidity rates in these patients. METHODS We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients : age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups : Group A (surgical clipping), Group B (coil embolization), and Group C (observation only). RESULTS Among the 109 patients, 56 (51.4%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. CONCLUSION Our results show acceptable favorable outcome of treatment-related morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.
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Affiliation(s)
- E-Wook Jang
- Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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20
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Cognitive function and anxiety before and after surgery for asymptomatic unruptured intracranial aneurysms in elderly patients. World Neurosurg 2010; 73:350-3. [PMID: 20849791 DOI: 10.1016/j.wneu.2010.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 04/01/2010] [Accepted: 01/14/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND The prevalence of patients with asymptomatic unruptured intracranial aneurysms (UIAs) will likely increase as the general population ages. The goal of the present study was to prospectively assess cognitive function and anxiety before and after surgical repair of asymptomatic UIAs in patients ≥ 70 years. METHODS A total of 28 patients ≥ 70 years with UIAs underwent cognitive testing using the Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale (WMS), and the Rey-Osterrieth Complex Figure test (ROCF) 1 month before and 1 month after surgery. All patients also underwent anxiety testing at these time points using the State-Trait Anxiety Inventory. RESULTS Group-rate analysis demonstrated that the performance intelligence quotient (IQ) and ROCF recall trial scores were significantly increased postoperatively, whereas there were no postoperative differences in verbal IQ, WMS, and ROCF copy trial scores. State anxiety scores were significantly decreased postoperatively, but there was no change in trait anxiety scores. Furthermore, a significant negative correlation was observed between changes in state anxiety scores and preoperative verbal IQ, performance IQ, and WMS. None of the patients developed postoperative cognitive functional impairments as demonstrated by event-rate analysis. CONCLUSIONS Surgical treatment of UIAs does not impair cognitive function and results in improvement in state anxiety in elderly patients.
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The impact of endovascular management on the outcome of aneurysmal subarachnoid hemorrhage in the elderly in eastern Finland. Acta Neurochir (Wien) 2010; 152:1493-502. [PMID: 20593208 DOI: 10.1007/s00701-010-0714-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The International Subarachnoid Aneurysm Trial (ISAT) concluded that "there is currently no reason to doubt that the reduction of dependent survival or death after endovascular coiling seen in all patients in the ISAT cohort should not be valid in the elderly". We feel that this generalization requires further investigation to assess its validity. METHODS We studied the impact of treatment era and independent risk factors for outcome in 179 consecutive elderly (> or =70 years) aneurysmal subarachnoid hemorrhage (aSAH) patients admitted to Kuopio University Hospital either between 1983 and 1992 (Era I, n = 56), prior to the introduction of endovascular management, or between 1995 and 2004 (Era II, n = 123) when the endovascular treatment was established at our institute. Altogether 150 patients underwent occlusive aneurysm treatment, 47 clipping in the Era I as against 49 clipping, 49 endovascular therapy, and five combination therapy in the Era II. RESULTS The 12-month survival (n = 179) did not improve from the Era I to the Era II. The proportion of good outcome (GOS IV-V) after occlusive therapy (n = 150) was equal in the Era I and Era II (n = 27/47; 57% vs. n = 56/103; 54%). In multivariate logistic regression analysis, independent predictors of poor outcome were age, poor grade (Hunt&Hess IV-V), hydrocephalus, hypertension, and intraventricular hemorrhage, but not the mode of occlusive therapy (microsurgical vs. endovascular) CONCLUSION Clinical severity of the SAH was the most significant predictor of outcome. Integration of coil treatment in clinical practice has not improved the overall outcome of aSAH in the elderly at our institute.
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22
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Proust F, Gérardin E, Derrey S, Lesvèque S, Ramos S, Langlois O, Tollard E, Bénichou J, Chassagne P, Clavier E, Fréger P. Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients. J Neurosurg 2010; 112:1200-7. [DOI: 10.3171/2009.10.jns08754] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The aim of the study was to assess postprocedural neurological deterioration and outcome in patients older than 70 years of age in whom treatment was managed in an interdisciplinary context.
Methods
This prospective longitudinal study included all patients 70 years of age or older treated for ruptured cerebral aneurysm over 10 years (June 1997–June 2007). The population was composed of 64 patients. The neurovascular interdisciplinary team jointly discussed the early obliteration procedure for each aneurysm. Neurological deterioration during the postprocedural 2 months and outcome at 6 months were assessed during consultation according to the modified Rankin Scale (mRS) as follows: favorable (mRS score ≤ 2) and unfavorable (mRS score > 2).
Results
Aneurysm sac obliteration was performed by microvascular clipping in 34 patients (53.1%) and by endovascular coiling in 30 (46.9%). Postprocedural neurological deterioration occurred in 30 patients (46.9%), related to ischemia in 19 (29.7%), rebleeding in 1 (1.6%), and hydrocephalus in 10 (15.6%). At 6 months, the outcome was favorable in 39 patients (60.9%). By multivariate regression logistic analysis, the independent factors associated with unfavorable outcome were age exceeding 75 years (p = 0.005), poor initial grade (p < 0.0001), and the occurrence of ischemia (p < 0.0001).
Conclusions
The baseline characteristics of SAH in the elderly were only slightly different from those in younger patients. In the elderly, the interdisciplinary approach may be considered useful to decrease the ischemic consequences.
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23
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[Aneurismal subarachnoid hemorrhage in the elderly subject. Should this patient participate in a randomized clinical trial?]. Neurochirurgie 2010; 56:67-72. [PMID: 20060549 DOI: 10.1016/j.neuchi.2009.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 09/01/2009] [Indexed: 11/23/2022]
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24
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Okamoto K, Horisawa R. Prediction of Subarachnoid Hemorrhage From a Ruptured Cerebral Aneurysm by Discriminant Analysis in Women. J Stroke Cerebrovasc Dis 2007; 16:245-50. [DOI: 10.1016/j.jstrokecerebrovasdis.2007.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 07/22/2007] [Accepted: 07/26/2007] [Indexed: 11/28/2022] Open
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25
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Lee HS, Kim YJ, You SH, Jang YG, Rhee WT, Lee SY. The incidence of aneurysmal subarachnoid hemorrhage in youngdong district, Korea. J Korean Neurosurg Soc 2007; 42:258-64. [PMID: 19096553 DOI: 10.3340/jkns.2007.42.4.258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 08/23/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. METHODS From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: 54.8+/-13.1 years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. RESULTS In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: 54.9+/-13.2 years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was 7.8+/-1.7, 10.5+/-2.7, and 9.1+/-2.1 per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was 8.8+/-1.4, 11.2+/-1.3 and 10.0+/-1.0, respectively in the coastal regions of Youngdong district from 1999 to 2006. CONCLUSION In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.
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Affiliation(s)
- Hyoung Soo Lee
- Department of Neurosurgery, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
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26
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Nieuwkamp DJ, Rinkel GJE, 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; 77:933-7. [PMID: 16638789 PMCID: PMC2077608 DOI: 10.1136/jnnp.2005.084350] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The number of elderly patients being admitted with aneurysmal subarachnoid haemorrhage (SAH) has been increasing. Treatment of the aneurysm may be offset by the higher rate of surgical or endovascular complications. AIM To study the clinical condition at onset, complications during clinical course, treatment and outcome in a consecutive series of elderly patients. METHODS Patients who were > or = 75 years at the onset of SAH were selected from the databases of two hospitals. Data on clinical condition at onset (poor condition defined as World Federation of Neurological Surgeons (WFNS) Scale IV and V), clinical course, treatment and outcome were extracted. Univariate and multivariate regression analyses were carried out to identify predictors for in-hospital death and poor outcome, defined as death or dependency. RESULTS The data of 170 patients were retrieved, of whom 25 (15%) patients were independent at discharge; none of these patients had been admitted in a poor condition. Poor clinical condition on admission (odds ratio (OR) 7.9; 95% confidence interval (CI) 3.7 to 17) and recurrent haemorrhage (OR 7.5; 95% CI 2.5 to 23) were the strongest predictors for in-hospital death. Recurrent haemorrhage was the strongest predictor for poor outcome in the subset of patients who were admitted in good clinical condition. In all, 10 of 47 (21%) patients were independent at discharge after neurosurgical clipping (n = 34) or endovascular coiling (n = 13). CONCLUSION Elderly patients with SAH have a poor prognosis. The effect of the initial haemorrhage is the most common reason for poor outcome. For patients who are admitted in good clinical condition, the most important complication leading to poor outcome is recurrent haemorrhage. Treatment of the aneurysm in patients > or = 75 years is feasible, may improve the outcome and should be strongly considered in patients who are admitted in a good condition.
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Affiliation(s)
- D J Nieuwkamp
- Department of Neurology, University Medical Centre Utrecht, C03.236, PO Box 85500, 3584 CX Utrecht, The Netherlands.
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Cai Y, Spelle L, Wang H, Piotin M, Mounayer C, Vanzin JR, Moret J. Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients. Neurosurgery 2005; 57:1096-102; discussion 1096-102. [PMID: 16331156 DOI: 10.1227/01.neu.0000185583.25420.df] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older.
METHODS:
Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed.
RESULTS:
Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly.
CONCLUSION:
The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.
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Affiliation(s)
- Yiling Cai
- Neuroradiological Intervention Service, Hospital of the Rothschild Foundation, Paris, France
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Horiuchi T, Tanaka Y, Hongo K. Surgical Treatment for Aneurysmal Subarachnoid Hemorrhage in the 8th and 9th Decades of Life. Neurosurgery 2005; 56:469-75; discussion 469-75. [PMID: 15730571 DOI: 10.1227/01.neu.0000153926.67713.b8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 12/09/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Industrialized countries are facing a rapid increase of their senior populations. Consequently, the number of elderly patients with aneurysmal subarachnoid hemorrhage is increasing. The purpose of this study was to assess the results of surgical repair for ruptured aneurysm in elderly patients.
METHODS:
We retrospectively investigated elderly patients (ages 70–89 yr) who were undergoing surgical treatment for ruptured aneurysm during the 15-year period 1988 to 2002 and compared patients in the 8th and 9th decades of life. Generally, patients were treated surgically within 72 hours after ictus.
RESULTS:
Of the total of 2835 patients, there were 509 patients (18.0% of total patients) in the 8th decade and 99 patients (3.5%) in the 9th decade of life. Because data were incomplete and patients who received ventricular drainage or ventriculoperitoneal shunt without aneurysmal repair were excluded, 449 and 89 patients in the 8th and 9th decades of life, respectively, were analyzed. No differences in sex, preoperative grade, preoperative computed tomographic findings, location of aneurysm, and aneurysm size were observed between the two decades. Preoperative grade and computed tomographic findings were predictors of favorable outcomes in the 8th and 9th decades. Patient age was a significant predictor of outcome in the 8th but not in the 9th decade.
CONCLUSION:
To the best of our knowledge, this study is the largest series of its kind to date. Advanced age alone does not exclude adequate surgical repair in patients with aneurysmal rupture in the 9th decade of life.
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Affiliation(s)
- Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
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Suyama K, Kaminogo M, Yonekura M, Baba H, Nagata I. Surgical treatment of unruptured cerebral aneurysms in the elderly. ACTA NEUROCHIRURGICA. SUPPLEMENT 2005; 94:97-101. [PMID: 16060247 DOI: 10.1007/3-211-27911-3_15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
We retrospectively analyzed the prevalence and surgical outcomes of unruptured cerebral aneurysms in the elderly for the past five years. Between 1998 and 2002, we collected data from 575 subjects with unruptured aneurysms who had no history of subarachnoid hemorrhage (SAH). One hundred and eighty-two of these patients (31.7%) were aged > or = 70 years and they had 233 aneurysms. The proportion of older patients among all subjects increased significantly from 21.4% in 1998 to 40.3% in 2002. Unruptured aneurysms found in the elderly had a predominance of female, higher frequency of multiple aneurysms, and lower frequency of anterior communicating artery aneurysms when compared with those in the younger patients. The majority of intradural aneurysms detected in the elderly were less than 10 mm in diameter (84.8%). One hundred and eleven out of 224 intradural aneurysms in the elderly were treated (49.6%); most aneurysms were directly clipped, while only 13 aneurysms including six basilar artery aneurysms were coiled endovascularly. Among the 83 elderly subjects who underwent direct surgery, perioperative complication appeared in seven subjects (morbidity 8.4%, mortality 1.2%). No SAH occurred postoperatively and conservatively during 1-5 years of follow-up. Since the rupture rate of small unruptured aneurysms without SAH history is reported to be low, surgical indication should be considered with care particularly in the elderly.
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Affiliation(s)
- K Suyama
- Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan.
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Hamada JI, Morioka M, Yano S, Kai Y, Ushio Y. Incidence and early prognosis of aneurysmal subarachnoid hemorrhage in Kumamoto Prefecture, Japan. Neurosurgery 2004; 54:31-7; discussion 37-8. [PMID: 14683538 DOI: 10.1227/01.neu.0000097196.55204.0b] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2003] [Accepted: 08/28/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We analyzed the community incidence and early prognosis of first-ever aneurysmal subarachnoid hemorrhages (SAHs) to obtain the same prognostic information used by physicians and families in a defined geographic area in Japan. METHODS During the 5-year period from January 1, 1996, to December 31, 2000, 2115 patients were registered in the Data Bank for Cerebral Aneurysms of Kumamoto Prefecture, a defined area in Japan with a population of 1.86 million. Registration was based on a comprehensive referral system for SAH patients; computed tomographic scans were available for all patients, including those who were moribund or dead on arrival. We compared the treatment outcomes at 3 months after the first-ever SAH in surgically and conservatively treated patients. RESULTS The age-adjusted annual incidence of SAH for men, women, and both sexes was 15.9, 26.6, and 21.6 per 100,000 person-years, respectively. In men, the incidence reached a plateau after age 40 years. In women, conversely, it rose after age 40 and peaked in the 9th decade of life. Of the 1634 surgically treated patients, 1153 (70.6%) had a favorable outcome; this was true for only 27 of 477 (5.7%) conservatively treated patients. Four patients were lost to follow-up. The clinical outcome did not differ between patients treated by open surgery and those treated endovascularly. Approximately 30% of our patients were older than 70 years at the time they experienced their first SAH. CONCLUSION The incidence of SAH obtained in this study was similar to earlier Japanese reports and Finnish studies. The importance of managing elderly patients with cerebral aneurysms will continue to increase.
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Affiliation(s)
- Jun-ichiro Hamada
- Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto, Japan.
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Matsumoto K, Akagi K, Abekura M, Nakajima Y, Yoshiminie T. Investigation of the surgically treated and untreated unruptured cerebral aneurysms of the anterior circulation. ACTA ACUST UNITED AC 2003; 60:516-22; discussion 522-3. [PMID: 14670666 DOI: 10.1016/s0090-3019(03)00318-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The natural history of unruptured cerebral aneurysms and the surgical risks are modified by several factors including size, location, and presence of subarachnoid hemorrhage (SAH). The main confusion arises because the backgrounds of the past reports describing the natural history or the surgical complication of unruptured cerebral aneurysms were different. The present study aimed to adjust the backgrounds and investigate the surgical indication with close monitoring of both surgically treated and untreated unruptured cerebral aneurysms. METHODS In the past 9 years, 201 patients who had unruptured anterior circulation aneurysms were monitored. The decision of the operation was not randomized. The patients were divided into three subgroups by the size of the aneurysms (small group: below 5 mm, medium group: between 5 and 15 mm, large group: over 15 mm). In both surgically untreated and treated patients, overall mortality and morbidity corresponding to Rankin score II or worse was counted as unruptured aneurysm related event. The ratio of event free was compared between surgically treated and untreated patients using Log-rank test. RESULTS In untreated patients, SAH was noted in 1 in the small group and 4 in the medium group. The annual rupture rate of the medium group was 12 times higher than that of the small group. In surgically treated patients, overall mortality and morbidity of the surgery was 2.3% in the small group, 3.6% in the medium group, and 20% in the large group. One surgically treated patient had SAH because of regrowth of aneurysm. When ratio of event free was compared, no significant advantage of surgery was noted in the small group and in all of the patients. However, the benefit of surgery was significant in the medium group (Log-rank p = 0.0189). CONCLUSIONS The present results indicated that prophylactic surgery has a benefit for the medium-size aneurysms (5-15 mm) of the anterior circulation. For large aneurysms, individual investigation is necessary because of the variety of surgical difficulties, and the complex symptoms because of rupture and the mass effect as well as cerebral embolism. In small aneurysms, careful observation may be a reasonable choice unless the aneurysm is at a specially high risk of rupture.
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Affiliation(s)
- Katsumi Matsumoto
- Department of Neurosurgery, Stroke Center, Wakakusa Daiichi Hospital Higashi, Osaka, Japan
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Vogel T, Verreault R, Turcotte JF, Kiesmann M, Berthel M. Intracerebral aneurysms: a review with special attention to geriatric aspects. J Gerontol A Biol Sci Med Sci 2003; 58:520-4. [PMID: 12807922 DOI: 10.1093/gerona/58.6.m520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Rupture of an intracranial aneurysm (ICA) remains a devastating complication associated with a high degree of morbidity and mortality. In the past 2 decades, older people were often excluded from active treatment on the unique basis of their chronological age. Recent developments of less-invasive techniques for the diagnosis and treatment of ruptured and unruptured ICAs suggest that this fatalistic attitude toward older patients should be reconsidered. Furthermore, taking into account the heterogeneity of the elderly population, the use of a comprehensive geriatric assessment approach, based on a multidisciplinary evaluation, appears particularly helpful in proposing the optimal treatment strategy for each older patient. This article reviews the geriatric features of epidemiological, physiopathological, as well as clinical and therapeutic aspects of ruptured and unruptured ICAs.
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Affiliation(s)
- Thomas Vogel
- Centre de Gérontologie, Hôpital de la Robertsau, Strasbourg, France.
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Pinsker MO, Gerstner W, Wolf S, Trost HA, Lumenta CB. Surgery and outcome for aneurysmal subarachnoid hemorrhage in elderly patients. ACTA NEUROCHIRURGICA. SUPPLEMENT 2003; 82:61-4. [PMID: 12378993 DOI: 10.1007/978-3-7091-6736-6_12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE The goal was to report treatment results of elderly patients (over 70 years) who underwent clipping of aneurysms after subarachnoid hemorrhage (SAH). MATERIAL AND METHODS From 1994 to 2000 41/284 (14%) patients older than 70 years were operated on aneurysmal SAH in our department. Localization of ruptured aneurysm was anterior communicating artery (n = 14), middle cerebral artery (n = 14), internal carotid artery (n = 6), anterior cerebral artery (n = 2), pericallosal artery (n = 1) and multiple in 4 patients. We used the Hunt and Hess classification for initial grading and the Glasgow Outcome Score at day 30 after surgery. RESULTS Patients with HH 1-3 had a low mortality (1/18, 6%), whereas 9 of 23 patients (39%) with HH 4-5 decreased within 30 days after surgery. Overall mortality was 24.5% (10/41) at 30 days after surgery. Most patients (n = 32) underwent early surgery (within 72 hours). Shunt dependent hydrocephalus developed in 15 patients (37%). The outcome was better in patients graded HH 1-3, in those without serious atherosclerotic changes in angiography, and in AcoA and ICA localization compared to MCA. CONCLUSION Advanced age does not preclude successful surgery for ruptured aneurysm. Most important factor for outcome was a good initial clinical status, though the majority of our patients presented with poor grades. Early surgical clipping and postoperative intensive care can attain a favorable outcome in a significant percentage of elderly patients.
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Affiliation(s)
- M O Pinsker
- Department of Neurosurgery, Academic Hospital Munich-Bogenhausen, Munich, Germany
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Griva F, Tartara F, Longo A, Oliveri G, Boccaletti R. Management of Cerebral Aneurysms in Elderly Patients. ACTA ACUST UNITED AC 2002. [DOI: 10.1177/197140090201500516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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.
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Affiliation(s)
- F. Griva
- Department of Neurosurgery, Giovanni Bosco Hospital, Torino; Italy
| | - F. Tartara
- Department of Neurosurgery, Giovanni Bosco Hospital, Torino; Italy
| | - A. Longo
- Department of Neurosurgery, Giovanni Bosco Hospital, Torino; Italy
| | - G. Oliveri
- Department of Neurosurgery, Giovanni Bosco Hospital, Torino; Italy
| | - R. Boccaletti
- Department of Neurosurgery, Giovanni Bosco Hospital, Torino; Italy
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Wang MC, Rubinstein D, Kindt GW, Breeze RE. Prevalence of intracranial aneurysms in first-degree relatives of patients with aneurysms. Neurosurg Focus 2002; 13:e2. [PMID: 15844874 DOI: 10.3171/foc.2002.13.3.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
A familial predisposition toward cerebral aneurysms has been previously described in patients with two or more affected family members. In the present study the familial incidence of unruptured intracranial aneurysms was studied in 96 patients with at least one first-degree relative (parent, sibling, or child) in whom a cerebral aneurysm was diagnosed.
Methods
All patients were between 20 and 70 years of age and underwent three-dimensional fast–spin echo magnetic resonance imaging. Sixty-one patients (63.5%) were women. The majority of patients (84%) were caucasian and the remainder were Hispanic (13%) or African-American (3%). No patient suffered a medical condition (excluding hypertension and smoking) known to be associated with cerebral aneurysm formation.
In four patients at least one aneurysm was found (two harbored multiple aneurysms). Three of the four patients were women. Two of the patients were siblings. The estimated prevalence in first-degree relatives was 4.2% (95% confidence interval 1.2–10.1). Of note, the mean age in the current study population was 39 years. The authors of recent metaanalyses have suggested that the prevalence of nonfamilial aneurysms is approximately 2%, despite earlier reports in which higher figures were cited.
Conclusions
The authors conclude that first-degree relatives of patients with aneurysms are at higher risk for harboring an intracranial aneurysm.
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Affiliation(s)
- Marjorie C Wang
- Department of Neurosurgery, University of Colorado Health Sciences Center, Denver 80262, USA
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Chung RY, Carter BS, Norbash A, Budzik R, Putnam C, Ogilvy CS. Management outcomes for ruptured and unruptured aneurysms in the elderly. Neurosurgery 2000; 47:827-32; discussion 832-3. [PMID: 11014421 DOI: 10.1097/00006123-200010000-00006] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In a patient older than 70 years, the decision to treat an intracranial aneurysm remains difficult whether it is ruptured or unruptured. We sought to review our institutional risks of treatment of such lesions in the context of the risks of rupture and its associated morbidity and mortality in this age group. METHODS One hundred twenty-nine consecutive patients aged 70 years or older, who were treated at a single institution for an intracranial aneurysm, were retrospectively reviewed. Forty patients were treated for unruptured aneurysms, and 89 patients presented after subarachnoid hemorrhage. Seven additional patients in this age group who had solely intracavernous lesions, as well as one patient with a dolichoectatic fusiform basilar lesion, were excluded. Management outcomes were assessed using a modification of the Glasgow Outcome Scale, and additional physical and functional disability was assessed using the Barthel index and the Reintegration to Normal Living index. RESULTS Six-month outcomes for the unruptured group were: excellent, 70%; good, 15%; fair, 5%; poor, 7.5%; and death (2.5%). Outcomes for all patients with ruptured lesions (including those not offered aggressive therapy) were: excellent, 34%; good, 9%; fair, 5.6%; poor, 3.4%; and death, 45%. Long-term follow-up was performed by questionnaire to assess physical and functional disability. Although physical disability (Barthel index) was similar among survivors, the Reintegration to Normal Living index, a global assessment of function, was significantly higher in patients with unruptured aneurysms (84.8 versus 70.1; P = 0.05), which highlights the disabling effects of hemorrhage. CONCLUSION On the basis of an individual treatment center's management risks, annual aneurysmal rupture rates can be estimated that justify treatment in this difficult patient population. Despite recent controversy regarding aneurysmal hemorrhage rates, we think that symptomatic unruptured aneurysms should be treated and good results can be achieved, even in older patients.
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Affiliation(s)
- R Y Chung
- Cerebrovascular Surgery, Neurosurgical Service, Massachusetts General Hospital, Boston, USA
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