Proust F, Bracard S, Thines L, Pelissou-Guyotat I, Leclerc X, Penchet G, Bergé J, Morandi X, Gauvrit J-Y, Mourier K, Ricolfi F, Lonjon M, Sedat J, Bataille B, Drouineau J, Civit T, Magro E, Cebula H, Chassagne P, David P, Emery E, Gaberel T, Vignes J R, Aghakani N, Troude L, Gay E, Roche P H, Irthum B, Lejeune J-P
Department of Neurosurgery, Hautepierre Hospital, Strasbourg University Hospital, 67098, Strasbourg, France; Department of Neurosurgery, Charles-Nicolle Hospital, Rouen University Hospital, 76000, Rouen, France.
University Hospital, neuroradiology department, 54000 Nancy, France.
Neurochirurgie. 2020 Feb;66(1):1-8. doi: 10.1016/j.neuchi.2019.11.002. Epub 2019 Dec 18.
Population aging raises questions about extending treatment indications in elderly patients with aneurysmal subarachnoid hemorrhage (aSAH). We therefore assessed functional status 1 year after treatment.
This study involved 310 patients, aged over 70 years, with ruptured brain aneurysm, enrolled between 2008 and 2014 in a prospective multicentre trial (FASHE study: NCT00692744) but considered unsuitable for randomisation and therefore analysed in the observational arms of the study: endovascular occlusion (EV), microsurgical exclusion (MS) and conservative treatment. The aims were to assess independence, cognition, autonomy and quality of life (QOL) at 1 year post-treatment, using questionnaires (MMSE, ADLI, IADL, EORTC-QLQ-C30) filled in by independent nurses after discharge.
The 310 patients received the following treatments: 208 underwent EV (67.1%), 54 MS (17.4%) and 48 were conservatively managed (15.5%). At 1 year, independence rates for patients admitted with good clinical status (WFNS I-III) were, according to the aneurysm exclusion procedure (EV, MS or conservative), 58.9%, 50% and 12.1% respectively. MMSE score was pathological in 26 of the 112 EV patients (23.2%), 10 of the 25 MS patients (40%) and 4 of the 9 patients treated conservatively (44%), without any statistically significant difference [Pearson's Chi test, F ratio=4.29; P=0.11]. Regarding QoL, overall score was similar between the EV and MS cohorts, but significantly lower with conservative treatment.
Elderly patients in good clinical condition with aSAH should be treated regardless of associated comorbidities. Curative treatment (EV or MS) reduced mortality without increasing dependence, in comparison with conservative treatment.
人口老龄化引发了关于扩大老年动脉瘤性蛛网膜下腔出血（aSAH）患者治疗指征的问题。因此，我们评估了治疗1年后的功能状态。
本研究纳入了310例年龄超过70岁的脑动脉瘤破裂患者，这些患者于2008年至2014年参加了一项前瞻性多中心试验（FASHE研究：NCT00692744），但被认为不适合随机分组，因此在该研究的观察组中进行分析：血管内栓塞（EV）、显微手术夹闭（MS）和保守治疗。目的是在出院后由独立护士填写问卷（MMSE、ADLI、IADL、EORTC-QLQ-C30），评估治疗1年后的独立性、认知、自主性和生活质量（QOL）。
310例患者接受了以下治疗：208例行EV（67.1%），54例行MS（17.4%），48例接受保守治疗（15.5%）。1年后，临床状态良好（WFNS I-III级）入院患者的独立率，根据动脉瘤排除程序（EV、MS或保守治疗）分别为58.9%、50%和12.1%。112例EV患者中有26例（23.2%）MMSE评分异常，25例MS患者中有10例（40%），9例接受保守治疗的患者中有4例（44%），无统计学显著差异[Pearson卡方检验，F值=4.29；P=0.11]。关于生活质量，EV组和MS组的总体评分相似，但保守治疗组明显较低。
临床状况良好的老年aSAH患者无论有无合并症均应接受治疗。与保守治疗相比，根治性治疗（EV或MS）可降低死亡率且不增加依赖程度。
