Until 2001, subarachnoid hemorrhage (SAH) patients aged 80 years or older were, as a rule, treated with delayed surgery or conservative methods at our department. Since 2002, with the introduction of endovascular treatments, we have offered acute surgery as a treatment option for SAH patients aged ≥80 years. In the present study, we examined the effect of acute surgery on clinical outcomes in these elderly patients.
The subjects were 34 patients aged ≥80 years who had been admitted to our hospital with a diagnosis of SAH (Hunt and Kosnik grade 1 to 4). The subjects were divided into two groups according to the admission time: the early group included patients admitted through 2001, and the late group included those admitted in 2002 or later. Patients in the early group received conservative treatment, while those in the late group were offered acute surgery as a treatment option. Neurological conditions, cerebral aneurysm localization, and clinical outcomes at the time of discharge were compared between the two groups.
The early group consisted of 13 patients ranging in age from 81 to 88 years. On admission, 6 patients had severe neurological conditions (Hunt and Kosnik grade 4). Cerebral aneurysms were located at the internal carotid artery (n = 2), anterior communicating artery (n = 1), and vertebral or basilar artery (n = 2). The remaining patients were not tested (n = 8). The modified Rankin scale scores at discharge were 0 to 3 (2 patients) and 6 (11 patients). The late group included 21 patients ranging in age from 80 to 92 years. On admission, 9 patients had severe neurological conditions (Hunt and Kosnik grade 4). Cerebral aneurysms were located at the internal carotid artery (n = 12), middle cerebral artery (n = 5), anterior communicating artery (n = 2), and vertebral or basilar artery (n = 2). Fifteen of the 21 patients underwent acute surgery (clipping in 8 patients and coil embolization in 7 patients). The modified Rankin scale scores at discharge were 0 to 4 (9 patients), 5 (6 patients), and 6 (6 patients). There were no significant differences in age or neurological condition between the two groups. Mortality at the time of discharge was significantly lower in the late group than in the early group. Although it was not statistically significant, the percentage of patients who were discharged to their home (modified Rankin scale scores of 0 to 4) in the late group was approximately three times higher than that in the early group. Of the patients who underwent surgery, 6 had poor clinical outcomes at the time of discharge (modified Rankin scale scores of 5 or 6), attributable mainly to symptomatic cerebral vasospasm and complications of surgery. The incidence of symptomatic cerebral vasospasm was noted to be significantly higher in these subjects than in SAH patients younger than 80 years.
We consider prevention of symptomatic cerebral vasospasm and complications of surgery to be essential for improving the clinical outcomes of elderly SAH patients undergoing acute surgery.