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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

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SAH in the elderly patient – Treatment and outcome

SAB bei geriatrischen Patienten - Therapie und Outcome

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  • corresponding author Veit Braun - Neurochirurgische Klinik der Universität Ulm am BKH, Günzburg
  • S. A. Rath - Neurochirurgische Klinik am Klinikum Deggendorf, Deggendorf
  • G. Antoniadis - Neurochirurgische Klinik der Universität Ulm am BKH, Günzburg
  • K. Seitz - Neurochirurgische Klinik der Universität Ulm am BKH, Günzburg
  • W. Börm - Neurochirurgische Klinik der Universität Ulm am BKH, Günzburg
  • H. P. Richter - Neurochirurgische Klinik der Universität Ulm am BKH, Günzburg

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. DocMO.07.01

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0071.shtml

Published: April 23, 2004

© 2004 Braun et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

From January 1999 to May 2003, 316 aneurysms were treated, among them 40 patients (12,7 %) over 65 years with subarachnoid hemorrhage. The results of this sub-group are presented.

Methods

The ages ranged from 65 to 83 years (average 71 years), 16/40 (40%) of the patients were in Hunt&Hess °I-III, 60% °IV-V. 85 % of the aneurysms were located in the anterior circulation. Twenty-one patients were initially treated micro-neurosurgically (18 clipped, 2 wrapped and 1 parent vessel occlussion, most MCA and broad-based ACom aneurysms); 19 were coiled (all basilar tip and small-based ACom aneurysms), but 2 of them re-bled (10,5 %) and were subsequently clipped. 66,7 % of the coiled and 60,0 % of the clipped patients had been hospitalized in poor condition (H&H IV-V). The mean follow-up period was 16 months.

Results

Overall 14/40 patients (35 %) fully recovered, 2 (5 %) returned to everyday life with some deficit, 13/40 (33 %) remained dependent, 11/40 (27 %) died. All 7 patients with MCA aneurysms and intracerebral hematoma were clipped, 4 died, 3 remained dependent. Surprisingly 25 % (6/24) of °IV-V patients fully recovered, but an almost equal number (7/24 = 29 %) died. The number of recovered patients was higher in the coil group (58,8 %) compared to 36,4 % in the clip group (patients with intracerebral hemorrhage excluded). Surprisingly the outcome was independent of age, which ranged from 65-83 years in the group with good or fair outcome (average 71 years).

Conclusions

The majority of elderly patients with subarachnoid hemorrhage were admitted to the hospital in a bad condition. Whereas additional intracerebral hemorrhage is linked to a bad outcome, 47,1 % of the pure SAH patients fully recovered, including even patients in poor primary grade. The chance of full recovery is independent of age. This result justifies even a cost-intensive treatment in our opinion. The less traumatic coiling seems to be superior to clipping primarily. Unfortunately, our geriatric patients did not, normally, show up for regulary angiographic control. Therefore re-bleeding due to coil compaction has to be feared.