Journal of Neurosurgical Sciences 2019 Oct 28

DOI: 10.23736/S0390-5616.19.04743-X

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Subarachnoid hemorrhage in the eighties: to treat or not to treat

Leonello TACCONI ¹ ✉, Roberto SPINELLI ¹, Francesco SIGNORELLI ²

¹ Neurosurgical Unit, Azienda Universitaria Integrata, Trieste, Italy; ² Neurosurgical Unit, University “Aldo Moro” of Bari,; Medical School, Bari, Italy

BACKGROUND: Life expectancy has in the last few years increased and, as a consequence, also the number of elderly patients admitted to an emergency department with aneurysmal subarachnoid hemorrhage. We wanted to detect any differences in term of outcomes and adverse events between two groups of patients of different age, in relation to types of treatment and clinical status at presentation.
METHODS: We selected and analyzed two groups of patients (Group A and Group B) among 458 retrospectively collected cases admitted to two neurosurgical centers with a diagnosis of aneurysmal subarachnoid hemorrhage over a 7.5-year period. Group A included 46 patients equal or older than 80 years and Group B all the rest. Data were collected on age, sex, aneurysm location, size, comorbidities, clinical condition at presentation and at follow-up.
RESULTS:In group A, 19 patients underwent surgery, 16 were embolized, 7 were treated conservatively and 4 died very soon after admission. After a median follow up of 12 months 45.7 % of patients had a good outcome, 24% were in poor conditions and 21.7% had died. When we compared these results with the youngest group, we found some important statistically significant differences. Older patients were more prone to have surgical and medical related complications, whereas endovascular treatment seemed to be a more sustainable treatment in the elderly age group.
CONCLUSIONS: Elderly patients suffering from aneurysmal subarachnoid hemorrhage should be considered for treatment despite age, with endovascular embolization as the most preferable option. Without the treatment, the natural history can be very poor.

KEY WORDS: Subarachnoid hemorrhage; Aneurysm; Surgery; Coiling; Elderly; Octogenarian