Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India.
Department of Community Medicine and Government Medical College, Thiruvananthapuram, Kerala, India.
Neurol India. 2020 Jan-Feb;68(1):101-107. doi: 10.4103/0028-3886.279659.
The management of aneurysmal subarachnoid hemorrhage (SAH) in the elderly is challenging. Clipping as the definitive treatment is less well tolerated by the elderly population. The outcome is anticipated to be more glimmer in poor grade SAH and in a setup which lacks modern neurovascular gadgets. We present our experience of surgical clipping in elderly patients in such a basic neurovascular unit.
A retrospective analysis of hospital records of elderly patients between 70 and 79 of age who underwent surgical clipping of intracranial aneurysms between 2015 and 2017 was done. The patients' characteristics, comorbidities, aneurysm characteristics, intraoperative complications, and postoperative complications were studied to determine the factors influencing an unfavorable outcome. All information was entered into a database (Microsoft Excel) and analyzed using SPSS trial version 16. Outcomes were grouped into a favorable outomce which included Glasgow Outcome Scale scores of 4 and 5, whereas an unfavorable outcome which included Glasgow Outcome Scale scores of 1, 2, and 3.
There were 21 patients with aneurysms located either in the anterior or posterior circulation or both. All underwent standard craniotomy and clipping pertaining to that particular type of aneurysm. A favorable outcome was achieved in 48% of the patients and 52% had an unfavorable outcome. The duration of surgery, number of days on ventilator, and presence of hydrocephalus were the factors found to be statistically significantly associated with unfavorable outcomes.
A team approach consisting of a neuroanaesthetist, neurosurgeons, and critical care personnel can have a huge impact on the postoperative outcome.
老年人的颅内动脉瘤性蛛网膜下腔出血（SAH）的治疗极具挑战性。夹闭术作为明确的治疗方法，老年人群的耐受性较差。对于较差分级的 SAH 患者以及缺乏现代神经血管设备的情况下，预后预计更差。我们在这样的基本神经血管单位展示了我们对老年患者进行手术夹闭的经验。
回顾性分析了 2015 年至 2017 年间在 70 至 79 岁之间接受颅内动脉瘤手术夹闭的老年患者的医院记录。研究了患者的特征、合并症、动脉瘤特征、术中并发症和术后并发症，以确定影响不良预后的因素。所有信息均输入数据库（Microsoft Excel）并使用 SPSS 试用版 16 进行分析。结果分为良好预后，包括格拉斯哥预后量表评分 4 分和 5 分，而不良预后包括格拉斯哥预后量表评分 1 分、2 分和 3 分。
有 21 例患者的动脉瘤位于前循环或后循环或两者均有。所有患者均行标准开颅术并根据特定类型的动脉瘤进行夹闭。48%的患者取得了良好的预后，52%的患者预后不良。手术持续时间、呼吸机使用天数和脑积水的存在是与不良预后相关的统计学显著因素。
由神经麻醉师、神经外科医生和重症监护人员组成的团队方法可以对术后结果产生重大影响。
