Operative results of ruptured intracranial aneurysms in aged patients.

Abstract

During the five years between 1973 and 1978, 494 patients with intracranial aneurysms were operated on using a microsurgical procedure. One hundred forty-eight patients over 60 years of age were clinically analysed and were compared with those under 60 years of age. 1. In grade 1 and 2 of Hunt's classification, the patients over 60 had the same mortality rate (about 7 %) as the younger patients. The over-all success rate of 89.9 in the elderly group was similar to that in the younger group. 2. Following early operation, the mortality rate was 13.3 % for the elderly patients of grade 1 and 2, and 15.5 % for the younger ones. In the delayed operation, it was 4.3 % for the elderly patients, and 1.9 % for the younger ones. 3. The elderly patients with grade I and 2 had a lower morbidity rate in the early operation (30 %) than in the delayed operation (62.3 %), whereas the younger group showed no such difference. Mental symptoms such as disorientation were more common in the aged patients. 4. Surgical mortality was much higher in the elderly patients of grade 3, especially in those who underwent an operation within 2 weeks after hemorrhaging. Postoperative complications occurred more frequently in the elderly patients, especially in grade 3. 5. In patients of grade 4 and 5, the operative mortality and morbidity were very high in both the elderly and younger patients. These results suggest that grade 4 or 5 patients should be treated conservatively, unless a large intracranial hematoma is identified. 6. We conclude from these results that elderly patients in grade 1 and 2 should be treated surgically as soon as possible. In grade 3, surgical treatment should be delayed during the first two weeks of conservative treatment. Meticulous postoperative care of elderly patients is mandatory to prevent various complications.