gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Surgical treatment of intracranial aneurysms in elderly patients: Outcome and postoperative complications

Intrazerebrale Aneurysmen im hohen Erwachsenenalter: Ergebnisse und postoperative Komplikationen der chirurgischen Aneurysmabehandlung

Meeting Abstract

  • corresponding author Tobias Martens - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • U. Kehler - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 12.128

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0412.shtml

Veröffentlicht: 23. April 2004

© 2004 Martens et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Intracranial aneurysms in elderly patients is a subject of discussion regarding indication of surgical, endovascular or conservative treatment. There have only been a few studies concerning the outcome of surgical treatment of intracranial aneurysms in elderly patients.

Methods

In a retrospectively study we analysed the outcome, postoperative complications and duration of hospital stay of 38 patients under70 years with intracranial aneurysms, who have undergone surgical treatment in our department since 1990. The outcome was evaluated by using the Modified Rankin Scale (MRS). Mean follow-up was 67.0 days. The results were compared to the overall outcome of aneurysm clipping in patients younger < 70 years in our department.

Results

Twenty-seven of the evaluated patients were female, 11 were male. Mean age was 73.2 years (range 70-81). All surgically treated aneurysms were located in the anterior circulation. The size was 14.0 mm on the average (range 3-30). Initial Hunt and Hess grading was 1 or 2 in 39.5%, 3 in 15.8% and 4 or 5 in 23.7% of the cases. In addition there were 16 patients who were not treated due to unfavorable prognosis (n=13) or had refused of treatment (n=3). 63.2% of the surgically treated patients under70 years including all H&H grades showed a poor outcome (MRS 4,5 or 6) compared to 17.2% in the group < 70 years, which is of significant difference (p<0.001). 21.1% of the patients under70 years were at least able to look after their own affairs without assistance (MRS 0-2). This is significantly less than the 67.0% of the group < 70 years (p<0.001). Treatment mortality was 18.4% versus 3.2% (p<0.002). In contrast a subgroup of patients older than 70years admitted with H&H grade 1 and 2 good results (MRS 0-2) could be reached in as much as 46.7%. 20.0% were disabled (MRS 4 and 5) and mortality was 6.7%. The postoperative course of the patients over 70 years was frequently associated with severe complications such as cerebral infarction (n=14), severe brain edema (n=4), pneumonia (n=16) or sepsis (n=2). The mean time of hospital stay was 31.1 days compared to 22.4 days.

Conclusions

Surgical treatment of intracranial aneurysms in patients under70years is correlated with a high mortality, poor outcome and prolongation of hospitalization, in comparison to patients younger than 70years, especially when the initial Hunt and Hess grading is 3 or higher. Thus the indication for surgical treatment should be considered with great caution in these patients. More successful aneurysm surgery can be expected in patients under70years with an initial Hunt and Hess grading of 1 or 2. Hospital costs may be higher for this age group compared to younger patients, but should not be used to justify withholding care from this group.