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Current management of subarachnoid hemorrhage in advanced age

Norihito Shimamura1, Akira Munakata, Hiroki Ohkuma

  • 1Department of Neurosurgery, Hirosaki University School of Medicine, 5-Zaihuchou, Hirosaki Aomori pref. 036-8562, Japan. shimab@cc.hirosaki-u.ac.jp

Acta Neurochirurgica. Supplement
|December 3, 2010
PubMed

Insights

Management of aneurysmal subarachnoid hemorrhage (SAH) in elderly patients has shifted towards interventional treatments, improving outcomes. This study highlights the increasing use and effectiveness of these modern approaches in older populations.

Area of Science:

  • Neurosurgery
  • Interventional Neurology
  • Geriatric Medicine

Background:

  • Aneurysmal subarachnoid hemorrhage (SAH) poses significant risks, particularly in elderly patients (over 70 years).
  • Recent advancements in neurosurgical and endovascular techniques offer new management possibilities for this demographic.
  • Evaluating treatment trends and outcomes in advanced age SAH is crucial for optimizing patient care.

Purpose of the Study:

  • To analyze recent management strategies for aneurysmal subarachnoid hemorrhage (SAH) in patients over 70 years old.
  • To compare treatment approaches and outcomes between early (2001-2005) and late (2006-2009) periods.
  • To assess the impact of evolving treatment modalities on patient outcomes in advanced age SAH.

Main Methods:

  • Retrospective analysis of 372 aneurysmal SAH cases, including 123 elderly patients, treated between January 2001 and July 2009.
  • Division of patients into two groups based on treatment period: 2001-2005 and 2006-2009, with a focus on interventional treatment selection since 2006.
  • Analysis of Hunt-Kosnik (HK) grade, treatment methods, vasospasm rates, Glasgow Outcome Scale (GOS) at 30 days, and shunt operation ratios, using chi-square and t-tests for statistical analysis.

Main Results:

  • The proportion of interventional procedures in elderly patients increased significantly from 28% to 38%.
  • Coil embolization rates rose from 8% to 24%, and angioplasty rates increased from 22% to 76%.
  • Favorable outcomes (GOS) improved from 47% to 51%, while the rate of shunt surgeries decreased from 33% to 19%.

Conclusions:

  • Despite an increasing mean age and procedural shift towards interventional methods in elderly SAH patients, outcomes have improved.
  • Aggressive prevention and treatment of vasospasm, alongside acute-stage aneurysm treatment, are key to these positive results.
  • Interventional treatment strategies are essential for enhancing outcomes in advanced-age aneurysmal SAH cases.
Abstract

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