Intracranial aneurysm in elderly patients seem to differ in many aspects from those in patients their thirties, forties and fifties. During the past five years, the authors have experienced 42 cases of intracranial aneurysm (s) in patients over 60. These patients were divided into two groups. The first group consisted of those with moderate or marked arteriosclerosis and/or occlusive changes in the cerebral arteriography or CT scan (arteriosclerotic group). Cases without sclerotic or occlusive changes in the artery were included in second group (non-arteriosclerotic group). Prognosis was undoubtedly worse in the first group.
The authors analysed several factors affecting the prognosis. These included the patient's age, site of the aneurysm, grade of arteriosclerosis and occulusive changes, mode of surgical intervention, timing of operation and skillfulness of the operator. Our conclusion was as follows: (1) intentionally delayed operation is recommendable in cases with marked arteriosclerostic changes. Prognosis was poor in these cases if an operation was carried out in the acute stage. (2) surgical manipulation of the brain and vessels should be as protective as possible. Forceful and prolonged retiaction of these structures must be avoided. Operation should be done by skillful hands. (3) in patients with multiple aneurysms, only the ruptured aneurysm should be operated upon in the first operation. Unruptured aneurysm (s) should be left, or should be clipped at the second stage if feasible. (4) prudence is required in deciding on surgical intervention and the timing of the operation in patients with cerebral infarction. Conservative treatment is recommended in many such cases.
