MANAGEMENT AND LONG-TERM OUTCOME FOLLOWING SUBARACHNOID HEMORRHAGE AND INTRACRANIAL ANEURYSM SURGERY IN ELDERLY PATIENTS - AN AUDIT OF 199 CONSECUTIVE CASES

To address the question of managing subarachnoid haemorrhage (SAH) in the older patient, the management and outcome of 199 consecutive patients aged greater-than-or-equal-to 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). We conclude that angiography and surgical treatment of an intracranial aneurysm are advisable in patients aged 60 years or more in good neurological grade (WFNS less-than-or-equal-to 2) following SAH. The witholding of angiography and surgery from older patients with SAH solely on the grounds of advanced age is not justified.