2025 Volume 53 Issue 5 Pages 304-311
Background: While the number of treatments available for unruptured cerebral aneurysms in older patients is increasing with increasing population age, the suitability of each new procedure must be carefully considered, given that these are preventive surgeries. We report our analyses of outcomes of surgical treatment for unruptured cerebral aneurysms in older patients at our hospital.
Methods: We investigated the treatment of 66 older patients, comprising 10 cases of craniotomy and 56 cases of endovascular treatment performed surgically at our hospital between January 2006 and August 2023. We assessed age, underlying disease, reason for surgery, aneurysm diameter, location, length of hospital stay, modified Rankin Scale (mRS) scores at admission and discharge, and complications among 66 older patients.
Results: Endovascular treatment was most common among older patients (85% vs. 15%). Patients in the endovascular treatment group were significantly older (76.5±1.6 years vs. 79.9±4.0 years, p=0.010) and had more underlying diseases. Aneurysm diameter was larger in the endovascular treatment group (6.6±2.1 mm vs. 10.1±6.9 mm, p=0.110), and craniotomy was more common for middle and distal anterior cerebral artery aneurysms, while endovascular treatment was more common for internal carotid artery aneurysms and posterior circulation aneurysms (p=0.006). Although length of hospital stay was significantly shorter in the endovascular treatment group (32.3±20.5 days vs. 15.9±7.2 days, p<0.0001), no difference in mRS at admission and discharge was observed. Permanent complications occurred in five patients: one in the craniotomy group (10.0%) and four in the endovascular treatment group (7.1%). Declines in mRS (9 cases) were significantly more frequent in patients aged 78 years or older (p=0.041), with large aneurysms (p<0.0001) and with internal carotid artery (ICA) aneurysms or ICA and posterior communicating artery junction (IC-Pcom) aneurysms (p=0.026). The permanent complication rate was also significantly higher for patients aged 78 years or older (13.2%; p=0.046), with large aneurysms (20.0%; p=0.012) and with ICA or IC-Pcom aneurysms (13.8%; p=0.012).
Conclusions: Surgical treatment for unruptured cerebral aneurysms is useful for older patients. Indications should be carefully considered owing to the increased risk of complications in patients aged 78 years or older, those with large aneurysms, and those with ICA or IC-Pcom artery aneurysms.
