[Aneurysm surgery in the older patients (author's transl)]

A series of 9 patients over 70 years of age with saccular aneurysms, operated on by a direct surgery is reviewed in order to discuss the aneurysm surgery in the older patients. The median age of the patients was 74 years, and median interval from the hemorrhage to surgery was 18 days. Operative mortality was 11% and morbidity was 33%. Result of intracranial aneurysm surgery in the older patients depends on the surgical technique for the arteriosclerosis. 1. Treatment of the aneurysm neck must be abandoned when a severe arteriosclerosis exists around it. Subsequent to exposure of the whole aneurysm, a complete reinforcement of the aneurysm wall should be undertaken. 2. Especially gentle manipulation of the brain is necessary since small arteries are easily pulled out from the sclerotic artery. 3. The cerebral veins must be preserved as well as possible to avoid the venous congestion, which easily causes an intracerebral hematoma following brain retraction. 4. The frequency of pre and postoperative complications is high, but through vigorous care, they are kept under control. 5. It is best not to judge the surgical indication simply by the chronological age, but rather to consider the physical age including the laboratory findings. Therefore, other than cases of severe arteriosclerosis, the same principles for surgical indication in younger patients should be used for older patients.