[The indication to neuro-surgical intervention in higher age (author's transl)]

Higher life expectancy has entailed the necessity of treating syndromes in the age group over 60 more frequently. Therapy also includes surgical intervention in general and neurosurgery in particular. References in literature and cases from our own hospital showed that the necessity of performing surgery was extended to include persons of advanced age. Growing life expectancy during the last few decades was accompanied by an improvement in surgical techniques, in the substitution therapy of age-dependent dysfunctions, and the development of careful up-to-date anaesthesia. Good interdisciplinary cooperation resulted in a decisive reduction of the intra- and post-operative mortality rate, even if patients of higher age groups who underwent the selected major neuro-surgical interventions yet have twice the mortality rate (24 per cent) of patients under 60 (11.4 per cent). Early diagnosis is the weakest link in this chain. Cerebral and spinal symptoms in older people are often attributed to age-dependent factors of the vascular system. The space--occupying process is often recognized too late. Once the function of the CNS has failed, even risky interventions cannot bring about a favourable change in the disease.