Elective neck clipping for unruptured aneurysms in elderly patients

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Cerebrovascular Surgery

Background:

• Increasing diagnosis of unruptured aneurysms in elderly patients due to neuroimaging advancements.
• Limited critical analysis of surgical indications for this demographic.
• Need to evaluate outcomes and define criteria for intervention.

Purpose of the Study:

• To analyze outcomes of elective neck clipping for unruptured cerebral aneurysms in patients aged 70 and older.
• To identify factors influencing surgical success and failure.
• To elucidate appropriate surgical indications for this patient group.

Main Methods:

• Retrospective analysis of 96 patients (aged 70+) undergoing elective neck clipping for 103 unruptured cerebral aneurysms (1985-1997).
• Data collected on patient demographics, aneurysm characteristics (symptomatic/asymptomatic, location), and surgical outcomes.
• Statistical analysis, including multiple regression, to identify predictors of outcome.

Main Results:

• Good recovery achieved in 78.1% of patients; mild deficits in 12.5%, severe deficits in 4.2%, and mortality in 5.2%.
• Symptomatic patients showed significant improvement in quality of life (78.6% recovery).
• Aneurysm size and location (middle cerebral artery, internal carotid artery) were associated with poor outcomes.

Conclusions:

• Elective neck clipping is a viable option for unruptured aneurysms in the elderly.
• Symptomatic patients with simple, easily clip-able aneurysms are the primary candidates.
• Careful patient selection is crucial, avoiding temporary clip use when possible.