抄録
Factors affecting preoperative disease severity were studied in 220 elderly and younger patients who underwent surgery for ruptured intracranial aneurysms during the acute stage (within 3 days after onset). The patients' clinical status was evaluated 3 months postoperatively and the findings were compared by age group. The incidence of poor outcome was significantly higher in patients over 64 years old than in those under 65. Therefore, in this study, “elderly”p was defined as over 64 years of age. There were 41 elderly patients (13 males and 28 females; 68±3 years old) and 179 younger patients (97 males and 82 females; 52±8 years old). The preoperative neurological status was graded according to the classification of Hunt and Kosnik, excluding subsidiary conditions. There were significantly fewer grade 2 patients and significantly more grades 3-5 patients among the elderly than among the younger population (p<0.05). Medical history, occurrence of aneurysm rerupture, and computed tomography (CT) findings were studied and compared for clarification of the reasons for the high incidence of poor neurological status in the elderly group. CT findings were evaluated according to the method of Ohta et al. The incidence of cerebrovascular disease and head trauma was significantly higher in the elderly group. Furthermore, there were significantly more elderly patients whose CT score was 6 or more. However, the incidence of preoperative aneurysm rerupture and the severity of individual CT findings did not differ significantly between the two groups. Thus, a higher incidence of cerebral dysfunction due to pre-existing disorders and more extensive intracranial pathology consequent to rupture of aneurysms were considered responsible for the poorer preoperative neurological status in the elderly patients.
