gms | German Medical Science

Outcome of elderly patients with SAH is known to be less favourable than in younger patients [Inagawa et al]. Lanzino reported that the incidence of vasospasm is lower, but more often a symptomatic vasospasm is present in the elderly. In the scale of Hunt age is noted to be a factor that elevates the surgical risk. Therefore, we investigated our treatment results in this age group and the decision making wether to operate or not and the timing of intervention.

From 7/1993 until 12/2002 all patients older than 65 years with ruptured aneurysms treated either surgically/ endovascular/ conservative in our department were entered in the study. Severity of the SAH was graded according to the Hunt&Hess scale and the Fisher score. Furthermore, the location of the aneurysms was registered. Outcome was measured with the Glasgow-Outcome-Scale. Results were compared with outcome of all patients treated in our deparment with aneurysmal SAH.

From 7/1993 until 12/2002 103 patients older than 65 years (range 66-85 years) with ruptured aneurysms were treated. Clipping of one or more aneurysm were performed in 95 cases, one VA and one PICA aneurysm were coiled. Six patients had been treated conservative cause of the poor neurological state on admission. Good recovery (GOS 1-3) showed 70%, a poor outcome (GOS 4+5) 30%. ICH on initial ct-scan was followed by poor outcome.

Patients in this study aged >65 years showed a severe SAH in most cases, in 18% combined with a space occupying ICH. According to the literature this is a predictor of a less favourable outcome. Nonetheless, a large number of patients made a good recovery in this study. Patients graded H&H V in this age do not recover.