Surgical Management of Unruptured Cerebral Aneurysms in the Elderly: An Institution Experience

Clinical characteristics of intracranial aneurysms in elderly patents over 70 years old: a retrospective observational study

Background

Although the characteristics of intracranial aneurysms (IAs) in different age groups have been well documented, they remain relatively unclear in elderly patients due to a lack of large sample studies.

Methods

Data from IA patients aged more than 70 years who were treated in our centre from January 2016 to January 2020 were retrospectively collected.

Results

A total of 290 elderly patients (75.9% female) with a mean age of 74.0 ± 4.7 years were analysed. Rupture occurred in 60.7% of patients, 38.6% of whom presented with meningeal irritation, and seizures were noted in 2.3%. A total of 48.9% of the patients with ruptured IAs had initial symptoms presenting with slow development, and the mean delay from ictus was prolonged to 264.2 ± 914.0 hours. In addition, 61.9% of the patients with ruptured IAs had lesions with a maximum diameter of less than 5 mm. A total of 30.3% of the patients had multiple aneurysms, 35.5% had aneurysms with irregular shapes and 54.8% had cerebrovascular atherosclerotic stenosis (CAS). Pulmonary infection (n = 138, 47.6%), hydrocephalus (n = 72, 24.8%), and thrombosis (n = 35, 12.1%) were common complications during hospitalization. By the end of the 1-year follow-up, 22.1% of the patients had unfavourable clinical outcomes, and the mortality rate was 23.4%.

Conclusions

Several characteristics regarding IAs in elderly patients were reported, including an obvious female predominance; mild, slow initial symptom development causing prolonged admission delay; a low incidence of meningeal irritation and seizures due to decreased electrophysiological activity of the neurons; increased percentages of CAS, multiple aneurysms, and aneurysms with daughter sacs causing a high risk of rupture even for small lesions; a high risk of complications during hospitalization; and relatively poor clinical outcomes.

Impact of aneurysm location and endovascular treatment modality on the improvement of headache in patients with unruptured intracranial aneurysms

INTRODUCTION

The use of endovascular therapy (EVT) in patients with unruptured intracranial aneurysms (UIA) is associated with a significant reduction of headache severity. It is still unclear how the treatment modality and the aneurysm location affect headache in these patients. This systematic review and meta-analysis aimed to compare the improvement of headache rates based on the endovascular treatment modality and aneurysm location.

EVIDENCE ACQUISITION

We conducted a complete search through four databases. Original studies that reported the improvement in headache rates in patients that had undergone EVT for UIA based on the treatment modality and location were included in the analysis. Fixed effect meta-analysis was performed to compare them using the odds ratio (OR).

EVIDENCE SYNTHESIS

A total of 180 reports were screened for title and abstract, of which six reports were included in this study. There were 199 patients that underwent stent-assisted coiling and 184 patients who had coiling alone. A total of 75 patients with posterior aneurysms were included as compared to 347 with anterior aneurysms. There was no significant difference between the two treatment modalities regarding the improvement in headache rates (OR=0.591, 95% CI: 0.349-1.003, P=0.051). Additionally, no difference was found in headache improvement rates between posterior and anterior UIA (OR=0.738, 95% CI: 0.434-1.254, P=0.262).

CONCLUSIONS

There was no clear statistical difference between stent-assisted coiling and coiling alone for the improvement of headache in patients with UIA, as well as between posterior and anterior UIA. Future well-conducted large trials that use headache severity scores are warranted to investigate that further.