We retrospectively analyzed the outcome of patients with subarachnoid hemorrhage (SAH) who received surgical clipping in the acute stage between April 2007 and July 2012. Patients aged 80 and older were compared with those below 80. Patients were graded on admission according to the World Federation of Neurological Societies (WFNS) grade, and modified Rankin Scale (mRS) was used to evaluate outcome at discharge. During this period, 216 patients received clipping. There were 37 patients aged 80 and older among them. Their age ranged from 80 to 96 (average 84.4). Thirty-three (89%) were women. There was no significant difference related to grades between the two groups. The younger patients tended to have favorable outcomes. Better outcomes were obtained in both younger and elderly patients with WFNS Grade I–II. The patients with WFNS Grade III–V proved to have poor outcomes, especially in the elderly patients. The factors causing poor outcomes were primary brain damage in 9 (35%), disuse syndrome in 7 (27%), vasospasm in 5 (19%), and pneumonia in 2 (8%). We added cilostazol administration and increased nutritional support to the postoperative protocol from April 2010. Under the new protocol, the frequency of angiographic vasospasm (VS) decreased from 26% to 11%, symptomatic VS decreased from 26% to 6% and cerebral infarction related to VS decreased from 26% to 0%. The overall outcome tends to be better in patients after April 2010. However, significant differences have not been seen yet.
We conclude that favorable outcomes can be achieved even in elderly patients with ruptured cerebral aneurysms even if they are treated by surgical clipping, especially in the patients with WFNS Grade I–II.
Surgical clipping may be considered a treatment option even for elderly patients with ruptured cerebral aneurysms in the acute stage, especially when the endovascular surgery is unavailable.
