Hyung Dong Kim, M.D., Yeung Jin Song, M.D.
Department of Neurosurgery, College of Medicine, Dong-A University, Pusan, Korea
We compared clinical outcomes of different treatment modalities in geriatric patients with aneurysmal subarachnoid hemorrhage (SAH) to those of younger patients at our institution.
Materials and Methods:
Of a total of 964 consecutive patients with aneurysmal SAH who were treated with either microsurgical clipping (MC) or endovascular coiling (EC) from 1993 to 2004 at our institution, 175 patients were in the geriatric group and 789 patients in the younger group. In geriatric group, 162 patients underwent MC and 13 patients underwent EC. In younger group, 768 patients underwent MC and 21 patients underwent EC. Pre- and peri- operative parameters were retrospectively compared between two groups that may have prognostic values in selecting proper surgical treatment for geriatric patients with SAH.
In patients with MC, the Glasgow outcome scale (GOS) of younger group was associated with good recovery (GR) in 77.6%, moderate disability (MD) in 14.8%, severe disability (SD) in 2.7%, vegetative state (VS) in 0.6% and death in 4.3%, but in geriatric group 40.5%, 36.2%, 9.5%, 3.2% and 10.6%, retrospectively. The outcomes were different significantly in two groups.
On the other hand, in patients with EC, the GOS between the younger group and geriatric group were not significantly different when compared with same clinical grading on admission.
Early surgery and early ambulation in geriatric patients with SAH may be associated with better clinical outcome if general conditions are tolerable. The use of EC in geriatric patients especially over 70 years old seems to be a promising treatment option.