Aneurysmal subarachnoid haemorrhage: outcome of aneurysm clipping in elderly patients and predictors of unfavourable outcome.

OBJECTIVE

To determine the outcome of treatment of microsurgical clipping in elderly (60 - 70 years) patients with aneurysmal subarachnoid hemorrhage and determine the predictors of poor outcome.

STUDY DESIGN

Longitudinal analytical study.

PLACE AND DURATION OF STUDY

Nishtar Hospital, Multan, Mayo Hospital, Lahore, Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2000 to January 2010.

METHODOLOGY

Elderly patients (60 - 70 years) with ruptured cerebral aneurysm were enrolled and graded on the basis of World Federation of Neurosurgeons Scale (WFNS). Aneurysm sac obliteration was done in all the patients with microsurgical clipping. Postoperatively, the patients were assessed upto 3 months for outcome parameters i.e., neurological deterioration (based on WFNS grade and modified Rankin scale as favourable (mRS score ² 2) and unfavourable (mRS score > 2). The factors associated with unfavourable outcome were also noted which included age > 65 years, poor initial WFNS grade, and the occurrence of ischaemia.

RESULTS

The mean age of the 48 patients was 65 + 5.45 years. There were 31 (64.6%) male and 17 (35.4%) female patients. Postprocedural neurological deterioration occurred in 23 patients (47.9%) related to ischaemia in 14 (29.16%), rebleeding in 1 (2%), and hydrocephalus in 8 (16.66%). At 03 months, the outcome was favourable in 25 patients (52.08%) and unfavourable in 23 (47.91%).

CONCLUSION

In old patients, careful pre-operative assessment, interdisciplinary approach and meticulous tissue handling during aneurysm clipping may decrease the unfavourable outcome.