Horiuchi Tetsuyoshi, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Neurol Res. 2011 Oct;33(8):853-7. doi: 10.1179/1743132811Y.0000000013.
The incidence rate of aneurysmal subarachnoid hemorrhage (SAH) in the elderly is increasing. Although endovascular coiling has become a major form of treatment for SAH in elderly patients, not all ruptured aneurysms can be managed with an endovascular approach. Conventional surgical clipping still plays an important role in SAH treatment. The present study was performed to assess the outcome in patients older than 75 years of age in whom ruptured aneurysms were treated by clipping surgery.
This retrospective study included patients 75 years of age or older who underwent clipping surgery for ruptured cerebral aneurysms between 1988 and 2009. Age, gender, preoperative grade, Fisher grade, size, and location of the ruptured aneurysm were compared between cases showing favorable and unfavorable outcomes.
A total of 333 patients were analyzed. There were significant differences in preoperative grade, Fisher grade, and location of the aneurysm between the favorable and unfavorable outcome groups. In multivariate logistic regression analysis, independent predictors of unfavorable outcome were poor grade and ruptured anterior cerebral artery aneurysm, but not age of 80 years or older.
Advanced age did not represent a risk factor for poor outcome of clipping surgery in elderly patients. Although coil embolization has been shown to be a useful form of treatment, direct surgery should also be considered.
老年患者中动脉瘤性蛛网膜下腔出血（SAH）的发病率正在上升。尽管血管内栓塞已成为老年SAH患者的主要治疗方式，但并非所有破裂动脉瘤都能采用血管内治疗方法。传统的手术夹闭在SAH治疗中仍发挥着重要作用。本研究旨在评估75岁以上接受夹闭手术治疗破裂动脉瘤患者的预后。
这项回顾性研究纳入了1988年至2009年间75岁及以上因破裂脑动脉瘤接受夹闭手术的患者。比较预后良好和不良的病例之间的年龄、性别、术前分级、Fisher分级、破裂动脉瘤的大小和位置。
共分析了333例患者。预后良好和不良组之间在术前分级、Fisher分级和动脉瘤位置方面存在显著差异。在多因素逻辑回归分析中，不良预后的独立预测因素是分级差和大脑前动脉动脉瘤破裂，但不是80岁及以上的年龄。
高龄并非老年患者夹闭手术预后不良的危险因素。尽管线圈栓塞已被证明是一种有效的治疗方式，但也应考虑直接手术。
