Journal of Korean Society of Geriatric Neurosurgery 2017;13(2):49-53.
Published online September 30, 2017.
Surgical Outcomes of Trans-eyebrow Keyhole Surgery for Ruptured Intracranial Aneurysm in Elderly Patients
Jin Eun , Ik Seong Park
Departmet of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
Abstract
Objective
The transciliary supraorbital approach for anterior circulation aneurysm is a good alternative option instead of a conventional craniotomy. We investigated surgical outcomes of transciliary keyhole aneurysm neck clipping in elderly patients compared with adults at a single institute.
Methods
A retrospective cohort survey of medical records and images during the last eight years was conducted in patients who underwent keyhole craniotomy for cerebral aneurysms. The patients were classified as the adult (under 70 years old) and elderly (over 70 years old) group. Clinical status, radiologic findings, surgery-related complications, and long-term follow up results were compared between both groups.
Results
A total of 188 ruptured aneurysms were secured by keyhole surgery. Eighteen of the ruptured cases were in patients over 70 years old. The elderly group had worse clinical grades than the adult group. The mean aneurysm size and location was not different between the two groups. The surgical outcome by modified Rankin score (mRS) was worse in the elderly group. There was 1 case of a chronic subdural hematoma which required a burr hole drain in the elderly group compared to 2 cases in the elderly group.
Conclusion
The elderly group had worse outcomes than the adult group in patients with ruptured aneurysms treated with keyhole aneurysm clipping. A poor initial grade was the main cause of poor outcome. Although the effect of keyhole surgery is increasingly positive, careful selection is needed for keyhole aneurysm surgery in elderly patients.
Key Words: Craniotomy/methods, Cerebral aneurysm, Subarachnoid hemorrhage, Aneurysm, Ruptured/surgery


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