Abstract
Objective To compare the current treatment approach in elderly patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) and identify the independent predictors of the outcome after aggressive surgical treatment. Method This prospective, multicenter cohort study included 104 poor-grade aneurysmal SAH elderly patients, 60 years or older, treated in our institution from October 2010 to March 2013. Patients were grouped according to three treatment arms. Neurological outcome was assessed using the Glasgow Outcome Scale (GOS) at baseline and at a 12-month follow-up. Univariate and multivariate analysis were performed using the following factors: sex, age, smoking history, breathing ability, alcohol consumption, cerebral hernia, aneurysm location, aneurysm diameter, WFNS grade, CT Fisher grade, treatment approach, and the timing of the aneurysm surgery. Results At the 12-month follow-up, patients in the coiling group and clipping group had better prognosis than patients in the palliative treatment group. Univariate analysis confirmed that the treatment approach, WFNS grade, CT Fisher grade, and age are critical factors for neurological outcomes in poor-grade SAH. Multivariate analysis indicated that WFNS grade V, CT Fisher grades 3–5, and palliative treatment were independent predictors of poor prognoses. Conclusion Aggressive surgical treatment improves the prognoses in poor-grade aneurysm elderly patients with SAH. Elderly Patients of WFNS grade IV and CT Fisher grades 1-2 are more likely to have a better outcome.
Highlights
Subarachnoid hemorrhage (SAH) refers to a clinical symptom of direct extravasation of blood into the subarachnoid space caused by ruptures of the lesional vessels located at the brain base or surface
The proportion of poor-grade aneurysms in the elderly group was significantly higher than the younger group; this part of the patients are often facing a huge therapeutic challenge
We evaluated the effects of different treatment methods, both palliative treatment and aggressive treatment on neurological outcomes in poor-grade SAH elderly patients
Summary
Subarachnoid hemorrhage (SAH) refers to a clinical symptom of direct extravasation of blood into the subarachnoid space caused by ruptures of the lesional vessels located at the brain base or surface. SAH accounts for about 5% of all acute strokes and affects ∼30,000 Americans each year [1]. Despite advances in diagnostic methods and surgical and perioperative treatments, the outcomes for SAH patients remain poor, with population-based mortality rates as high as 45% and severe disability rates of ∼30% [2,3,4,5,6,7,8]. Poor-grade aneurysmal SAH patients (defined as World Federation of Neurological Surgeons (WFNS) grades IV and V) have the highest mortality and severe disability rates of all SAH types and, are often treated palliatively [9]. The incidence of SAH increases with advancing age. The elderly account for a significant number of the patients presenting with SAH [10]
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