Journal of Korean Society of Geriatric Neurosurgery 2009;5(1):25-34.
Published online June 30, 2009.
Clinical Characters & Surgical Treatment Results Analysis of Elderly Patients with Subarachnoid Hemorrhage
Kyu Ha Chong , Jong Hyun Kim , Joo Han Kim , Youn Kwan Park, Hung Seob Chung , Taek Hyun Kwon
Department of Neurosurgery, Korea University School of Medicine, Guro Hospital, Seoul, Korea
고령층 뇌지주막하 출혈 환자의 임상 특징 및 수술적 치료 결과 분석
고려대학교 의과대학 신경외과학교실
The mean age of Republic of Korea’ population has been prolonged, so the neurovascular diseases have been increased as many as other chronic elderly diseases. Therefore, age related analysis and study of elderly patients may expect to introduce more diversified results and factors assay. So, we had conducted an age related analysis of the clinical characters and surgical treatment’s results of elderly patients’ cases, who suffered with aneurismal subarachnoid hemorrhage (SAH).
& Methods: There was 330 patients, who admitted to the neurosurgical department at Korea University Guro hospital between September 2003 and June 2008, with a diagnosis of intracerebral aneurysm and treated (surgically 289 cases, intervention 41 cases). Ruptured aneurysm cases were 290, and non-ruptured cases were 40. Above all, who had SAH resulted from cerebral aneurysm and took surgical operation were 262. This study is a retrograde review of the medical records of those 262 cases.
The mean age of total cases were 53.1 years old. More than 60 years old were 68 cases (60’s:34 cases, 70’s:30 cases, more than 80 yrs old: 4 cases) which had 26.0% proportion of total cases. Overall, male to female ratio was 1:1.15 (male 122, female 140). But, the female ratio was significantly increased with advancement of ages, as 1:1.52 at 50’s, 1:1.62 at 60’s, and 1:6.5 at 70’s. Anterior communicating artery (A-comm) area was the most frequent area of aneurysm with 103 cases (39.3%). It was same at the over 60 years old cases with 21 cases (30.9%), but the aneurysm location with middle cerebral artery (MCA) area had increment of proportion. Overall, initial Hunt-Hess grade (H-H grade) I/II, III, and IV/V groups were, simultaneously, 151 cases (57.6%), 70 cases (26.7%), and 41 cases (15.7%). At over 60 years old cases, there were, simultaneously as above, 33 cases (47.1%), 23 cases (32.9%), and 14 cases (20.0%). Favorable outcome proportion at 60’s was 70.6% (24/34 cases), and at over 70 years old cases was 58.8% (20/34 cases). And at over 60 years old cases, the proportion of male was 64.7% (11/17 cases), and of female was 68.6% (35/51 cases). Surgical outcome with good recovery within H-H grade I/II group were 94.7% (143/151 cases). But with advancing ages, the proportion was decreased as 60’s for 88.2%, 70’s for 75%, and more than 80 years old group for 50%. The proportion of delayed ischemic neurologic deficit (DIND) cases who were confirmed by clinical and radiologic findings was 21.1% (55/262 cases), and it was was 30.9% (21/68 cases) at over 60 years old. The proportion of hydrocephalus which required ventriculo-peritoneal shunt operation was 6.9% (18/262 cases), and it was 17.6% (12/68 cases) at over 60 years old.
According to the retrospective study of 262 surgically treated aneurismal SAH patient analysis of recent 5 year, patients of above age 50 had female dominant characteristics, and the location of aneurysm was prominent at A-comm area, but with 70’s and 80 had tendency of increasing at MCA area. Poor initial H-H grade and Fisher’s grade were identified at elders at admission and had more major complications. Poor initial H-H grade and more frequent occurrence of SAH complications might distribute poor surgical outcome. But the age was not the factor that might contribute to poor surgical results, at our study. So, we suggest that advanced age patients with aneurysmal SAH may not be precluded for adequate surgical treatment.
Key Words: Subarachnoid hemorrhageㆍElderly patientㆍSurgical outcomeㆍPrognosis Factor

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