Management and long-term outcome following subarachnoid haemorrhage and intracranial aneurysm surgery in elderly patients: an audit of 199 consecutive cases

Br J Neurosurg. 1994;8(1):23-30. doi: 10.3109/02688699409002389.


To address the question of managing subarachnoid haemorrhage (SAH) in the older patient, the management and outcome of 199 consecutive patients aged > or = 60 years with a confirmed diagnosis of subarachnoid haemorrhage (n = 186) or an unruptured intracranial aneurysm (n = 13) were reviewed. In seven patients, the cause of the SAH was an arterio-venous malformation and these were excluded from further analysis. Angiography was performed in 141 patients with a complication rate of 2.1%. Angiography was not performed in 51 patients and, in this cohort, the in-patient mortality rate was 68.6% and only 27.5% had a favourable outcome at discharge. Operation was not performed in 21 patients with demonstrated aneurysms for a variety of reasons. In this group, the in-patient mortality rate was 47.6% and 38.1% had a favourable outcome at discharge. Eighty-one patients in good neurological grade underwent surgery for a ruptured aneurysm and six patients underwent surgery for a symptomatic unruptured aneurysm. The surgical mortality was 1.1% and a favourable outcome at discharge was achieved in 83.9% of patients. Thirty-three patients were angiographic negative and there was a favourable outcome in 97% of this group. The management mortality in these selected patients admitted to the Department of Clinical Neurosciences was 24.4% and a favourable outcome was recorded in 66.2% of patients. Long-term follow-up (median 40 months, range 3-120 months) was obtained in 97% of discharged patients. The probability of survival at 60 months for patients in good condition at discharge was 0.826 (95% confidence interval 0.722-0.894).(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / mortality
  • Aneurysm, Ruptured / surgery*
  • Cerebral Angiography
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / mortality
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / mortality
  • Subarachnoid Hemorrhage / surgery*
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome