We retrospectively analyzed the postoperative management of elderly patients with ruptured cerebral aneurysms and designed management policies for such cases. Sixty consecutive patients over the age of 70 years with ruptured cerebral aneurysms were operated on in an acute stage at our institution until 1998. The patients were classified as preoperative clinical grade and surgical outcome into four groups: 19 patients were Grade I to II according to the clinical grading scale of Hunt and Kosnik and recovered skills of daily living (Group 1), 8 patients were Grade I to II and had unfavorable outcomes (Group 2), 6 patients were Grade III to IV and had favorable outcomes (Group 3), and 27 patients were Grade III to IV and had unfavorable outcomes (Group 4).
In Group 1 and 3, the level of consciousness became alert and all cases were able to eat within a few days after the clipping of aneurysms. Mild hypoalbuminemia and hyponatremia were found in many of the cases. Although general complications required some treatment in over 70% of the cases, they resulted in the favorable outcomes.
In a few cases in Group 2 and 4, the level of consciousness improved after the operation but the patients were unable to eat. Marked hypoalbuminemia and sodium imbalance caused symptomatic vasospasm and general complications, which were responsible for the unfavorable outcomes.
In elderly patients with ruptured cerebral aneurysms, the recovery of consciousness as early as possible after the operations is required to achieve favorable outcome. Under sustained postoperative disturbance of consciousness, extensive care should be taken in the management of fluid and electrolyte balance, and nutrition.
