抄録
Factors affecting the outcome of early surgery (within 72 hours) for ruptured intracranial aneurysms were compared in an elderly and a younger population, and the causes of the relatively poor results among the elderly patients were analyzed. In this study, “elderly” was defined as 65 years of age or older, since the outcome was significantly poorer in these patients. 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 postoperative outcome, evaluated 3 months after onset, was rated in terms of the ability to carry out daily activities. Dependent and deceased patients were graded as having a poor outcome. The preoperative neurological status was graded according to the classification of Hunt and Kosnik, excluding the factor of serious systemic diseases. The proportion of elderly patients of grades 3-5 was significantly higher than that of younger patients (P<0.05). There was no significant difference in outcome among patients of grade 2, regardless of age. However, among patients of grades 3-5, the outcome was significantly poorer in the elderly group (p<0.05) . Therefore, the possible causes of the poor outcome among elderly patients of grades 3-5 were examined. Medical history, aneurysm rerupture, preoperative computed tomographic findings, surgical complications, vasospasm, and general and neurological postoperative complications were studied in particular. Vasospasm and general postoperative complications were identified as significant causes of poor outcome among the elderly. In addition, the incidence of severe vasospasm was significantly higher in the elderly group (p<0.025). In terms of general postoperative complications, the incidence of heart failure was significantly higher in the elderly patients (p<0.005). All patients who developed general complications also had vasospasm, and five of the seven elderly patients with heart failure developed severe vasospasm. These results suggest that, among elderly patients, poor outcome following early surgery for ruptured intracranial aneurysm is attributable to high incidences of poor preoperative neurological status, vasospasm, and general postoperative complications.
