Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients
François Proust, M.D., Ph.D., Emmanuel Gérardin, M.D., Ph.D., Stéphane Derrey, M.D., Sophie Lesvèque, M.D., Sylvio Ramos, M.D., Olivier Langlois, M.D., Eléonore Tollard, M.D., Jacques Bénichou, M.D., Ph.D., Philippe Chassagne, M.D., Ph.D., Erick Clavier, M.D., and Pierre Fréger, M.D.
Journal of Neurosurgery 112:1200-1207, 2010.
The aim of the study was to assess postprocedural neurological deterioration and outcome in patients older than 70 years of age in whom treatment was managed in an interdisciplinary context.
This prospective longitudinal study included all patients 70 years of age or older treated for ruptured cerebral aneurysm over 10 years (June 1997–June 2007). The population was composed of 64 patients. The neurovascular interdisciplinary team jointly discussed the early obliteration procedure for each aneurysm. Neurological deterioration during the postprocedural 2 months and outcome at 6 months were assessed during consultation according to the modified Rankin Scale (mRS) as follows: favorable (mRS score ≤ 2) and unfavorable (mRS score > 2).
Aneurysm sac obliteration was performed by microvascular clipping in 34 patients (53.1%) and by endovascular coiling in 30 (46.9%). Postprocedural neurological deterioration occurred in 30 patients (46.9%), related to ischemia in 19 (29.7%), rebleeding in 1 (1.6%), and hydrocephalus in 10 (15.6%). At 6 months, the outcome was favorable in 39 patients (60.9%). By multivariate regression logistic analysis, the independent factors associated with unfavorable outcome were age exceeding 75 years (p = 0.005), poor initial grade (p < 0.0001), and the occurrence of ischemia (p < 0.0001).
The baseline characteristics of SAH in the elderly were only slightly different from those in younger patients. In the elderly, the interdisciplinary approach may be considered useful to decrease the ischemic consequences.
KEYWORDS:elderly; subarachnoid hemorrhage; cerebral aneurysm; interdisciplinary treatment.