Abstract
This study was aimed to clarify the therapeutic guides for aged patients with ruptured cerebral aneurysms by comparing the clinical features of 81 younger patients between 40 and 64 years (Group A) with those of 38 patients aged over 65 years (Group B). We underwent clipping surgery in our hospital in the past 5 years. Postoperatively, they were managed by the hypervolemic and hyperdynamic therapies against the vasospasm (VS) under the continuous cardiopulmonary monitoring with Swan-Ganz (SG) catheter. The short-term (within 3 months after ictus) outcome was better in the aged patients operated on in the late stage than those in the acute stage. Symptomatic vasospasm (VS) occurred more frequently in Group B, especially in cases of Hunt and Kosnik Grade III and IV with the poor short-term outcome, than in Group A. In Group B, the poor cardiac response to dobutamine result in low cardiac output and pulmonary congestion, which limited the hypervolemic and hyperdynamic therapies. These therapies showed no effect on VS in many cases of Group B. In the cases of Group B with Glasgow Outcome Scale (GOS)>3 within 3 months follow-up, their long-term outcome was poor because of pulmonary and urinary tract infections and social problems. Our conclusions as follows: 1) Late clipping surgery is preferable for the aged patients in Hunt and Kosnik Grade III and IV. 2) Continuous monitoring of cardiopulmonary function with SG catheter is useful for the postoperative management of aged patients. 3) Social factors are an important determinant for the surgical indication in aged patients.
