gms | German Medical Science

Objective: Subarachnoid hemorrhage is a severe disease with high mortality and morbidity. Due to advances of neuroimaging, the number of unruptured intracranial aneurysms (UIA) is increasing. To choose an adequate and optimal treatment modality might be complicated, especially in older patients.

Methods: Between 2006–2010, 150 patients (102 women, 48 men, mean age 56) with 161 UIAs were treated. Data on procedural complications, clinical and radiological follow-up were analyzed in patients older than 60 years.

Results: Of patients undergoing coiling of UIAs, 40 patients (27%) were between 60–69 and 19 patients (13%) older than 70 years. For patients older than 70 years, endovascular therapy (n=6) was associated with cerebral infarction (n=2), intracerebral hemorrhage (n=1) and death (n=2). In one patient from the operative group (n=3), cerebellar hemorrhage occurred which was completely resolved without any neurological deficits at discharge. No therapy was performed in 10 patients (53%) of whom one patient developed a cerebral infarction. For patients 60–69 years old, 11 (27.5%) aneurysms were treated with clipping, 18 (45%) with endovascular coiling, and 11 (27.5%) conservatively. No significant periprocedural complications occurred in the treated groups, and the neurological outcome was good (modified Rankin Scale score 0–2). The choice of the treatment modalities was mainly related to the location, size and configuration of the aneurysm, risk factors and patient’s medical conditions. Psychological disposition also played an important role.

Conclusions: Despite ongoing controversy on the management of UIAs, older patients could also be treated effectively and safely. However, the indication including the treatment modality is recommended to be selected critically because of high morbidity and the treatment should be performed at an experienced neurovascular center.