Abstract
In our country, the onset of subarachnoid hemorrhage is occurring later in life, making the determination of treatment plans for unruptured cerebral aneurysms in elderly patients more important.
Fifty-one of 294 consecutive clipping operations for asymptomatic unruptured cerebral aneurysms less than 20 mm in diameter over the past 11 years were conducted on 50 elderly patients over 70 years old. All these patients were able to maintain independent lifestyles without deterioration in intellectual function or serious medical complications, and had an average hemispheric cerebral blood flow (CBF) of more than 35 ml/100 g/min preoperatively. We evaluated intellectual function using Wechsler Adult Intelligence Scale-Revised (WAIS-R) and frontal lobe function tests, and local CBF changes with SPECT before and after surgery. Long-term prognosis with modified Rankin Scale (mRS) was also assessed in 22 elderly patients who underwent direct surgery more than five years before.
Outcome at discharge in 48 patients was mRS 0 except for two patients with aggravation of renal dysfunction and venous infarction. The latter two patients were assessed at mRS 2. Evaluation of postoperative significant deterioration in intellectual function did not show significant differences between patients over 70 years old and non-elderly patients. Both diffuse hypoperfusion and focal reduction of CBF in ipsilateral frontal lobe were found more significantly in elderly patients (P<0.0001).
Among 21 patients followed more than five years after direct surgery, only one patient died, due to aggravation of renal insufficiency. For an average observation period of 102 months (63–143 months), long-term outcome was assessed at mRS 0 in 18 cases.
Direct surgery has little influence on outcome or intellectual function in elderly patients more than 70 years old when preoperative higher brain function and cerebral blood flow evaluation are considered. These patients can be expected to maintain normal functions as long as any healthy senior citizen.
