Department of Neuroradiology, Rothschild Foundation Hospital, Paris, F-75019, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
Department of Neuroradiology, Rothschild Foundation Hospital, Paris, F-75019, France.
Neurochirurgie. 2024 Jan;70(1):101522. doi: 10.1016/j.neuchi.2023.101522. Epub 2023 Dec 14.
The increase in life expectancy raises the question of the treatment of unruptured intracranial aneurysms in extremely old patients (>80 years). We present results in terms of occlusion and complications in both symptomatic and asymptomatic aneurysm.
All patients aged >80 years admitted to the Foundation Adolphe de Rothschild between January 1, 2005 and March, 2023 were included. Aneurysms were grouped as compressive and non-compressive. Procedural complications were grouped as symptomatic (i.e., leading to any temporary or permanent neurological deficit) and severe (defined by modified Rankin Scale (mRS) ≥3 at follow-up).
Forty-two aneurysms were treated in the study period. Coiling (with or without remodeling) was the treatment of choice in 30 patients. Eighteen patients had compressive aneurysm. Six complications occurred (14.2%), all ischemic. The majority of complications occurred in symptomatic aneurysms, in 4 patients (66.6%). One of the patients treated by flow-diverter had severe complications (mRs ≥3) with hemiplegia.
In extremely specific cases, treatment of unruptured aneurysm in people older than 80 years may be considered. Compressive aneurysm is associated with a high risk of complications. Treatments can be endovascular. Further prospective studies are required to confirm this hypothesis.
预期寿命的增加引发了一个问题，即如何治疗 80 岁以上的高龄患者的未破裂颅内动脉瘤。我们报告了有症状和无症状动脉瘤的闭塞和并发症结果。
我们纳入了 2005 年 1 月 1 日至 2023 年 3 月期间在 Adolphe de Rothschild 基金会就诊的所有 80 岁以上的患者。将动脉瘤分为压迫性和非压迫性。将程序并发症分为症状性（即导致任何暂时或永久性神经功能缺损）和严重（定义为随访时改良 Rankin 量表（mRS）≥3）。
在研究期间，共治疗了 42 个动脉瘤。30 例患者选择了弹簧圈（伴或不伴重塑）治疗。18 例患者有压迫性动脉瘤。发生了 6 例并发症（14.2%），均为缺血性并发症。大多数并发症发生在有症状的动脉瘤中，有 4 例（66.6%）。1 例接受血流导向装置治疗的患者出现严重并发症（mRS≥3），导致偏瘫。
在非常特殊的情况下，可以考虑治疗 80 岁以上的未破裂动脉瘤。压迫性动脉瘤与较高的并发症风险相关。治疗方法可以是血管内的。需要进一步的前瞻性研究来证实这一假设。
