Abstract
Aged patients were defined as those of 70 years or more of age.
In a consecutive series of 197 patients, who were operated on for ruptured anterior circulation aneurysm, 23 aged patients (12%) were analyzed in regards to the prognostic factors and outcome, as compared with 43 patients (22%) of 60 to 69 years of age (60's: 60 to 69 years of age).
The WFNS grading scale, CT grade of Fisher's and the site of ruptured aneurysm did not statistically differ in two groups. Hydrocephalus, requiring shunt operation, was significantly frequent (p<0.05) in the aged. Delayed ischemic neurological deficit occurred in 61% of the aged, and in 45% of the 60's, but this difference was statistically insignificant.
Postoperative sodium imbalance was observed in 74% of the aged and in 60% of the 60's, but this difference was statistically insignificant. The incidence of postoperative systemic complication was significantly high (p<0.02) in the aged, and cardiac complication, such as myocardial infarction and heart failure, was distinctive in the aged.
In serial measurement of mean hemispheric cerebral blood flow, reduced flow was persistently revealed in the aged, as compared with the 60's. The results of a long-term follow-up differ significantly (p<0.05) between two groups.
The outcome at 6 months after onset was significantly poor in the aged. Only 26% had good recovery in the aged, whereas 51% had good recovery in the 60's. This difference was statistically significant (p<0.05). None had good recovery in WFNS grade III and IV of the aged.
In conclusion, these results suggest that the poor outcome was due to high incidence of intracranial and systemic complications following acute stage operation, in addition to the poor brain plasticity in the aged. The aged patient, whose WFNS grade is I to II, achieved a reasonably good outcome and should be operated on in an acute stage.
