Factors for Favorable Outcome in Elderly Patients with Ruptured Cerebral Aneurysms

The outcome for patients with ruptured cerebral aneurysms is improving due to various adjunct treatments, but the prognosis in elderly patients is still poorer than that in younger patients. To evaluate whether surgical results of ruptured cerebral aneurysms were improved in the elderly, we analyzed the outcome of ruptured cerebral aneurysms in patients over 70 years old between 1989 and 2003. Forty-four patients and 66 patients were treated with neck-clipping between 1989 and 1993 (Group A) and between 1999 and 2003 (Group B), respectively. Fifteen patients (Group C) underwent endovascular embolization with Guglielmi detachable coils from 1999 through 2003. The outcome was favorable in 36% of Group A and 52% of Group B, respectively (P=0.15). Factors for unfavorable outcome, e.g., vasospasm, surgical, and general complications, occurred equally in Group A and B. In Group C, 67% of the patients between Grade I and III in Hunt and Hess grading showed favorable outcomes. Surgical results of ruptured cerebral aneurysms tend to improve in elderly patients, but the factors contributing to the outcome have not changed. It is supposed that the better outcome results from development of surgical technique, neurointensive care and rehabilitation. Endovascular treatment can be employed more aggressively in elderly patients because of its safety and efficacy.