Ruptured Intracranial Aneurysms in the Elderly: Epidemiology, Diagnosis, and Management

Sédat, Jacques; Dib, M.; Rasendrarijao, D.; Fontaine, Denys; Lonjon, M.; Paquis, Philippe

doi:10.1385/ncc:2:2:119

Cited by 18 publications

(11 citation statements)

References 66 publications

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“…Actually, they are treated in acute phase with good outcomes in the majority of patients 4 and the results depend on to their preoperative clinical condition. 1,14 .…”

Section: Surgical Proceduresmentioning

confidence: 99%

Surgical Treatment of Intracranial Aneurysms in Elderly

Aguiar¹,

Zicarelli²,

Melgar³

et al. 2018

jbnc

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Introduction: Twenty years ago, elderly patients who had a diagnosis of intracerebral aneurysms were considered to have a poor prognosis and, thus, were excluded of any kind of treatment. With the rapid aging of the population, there was a consistent increase on the prevalence of subarachnoid hemorrhage and, consequently, all of its complications. Delayed neurological deterioration from cerebral arterial vasospasm is a major cause of morbidity and mortality. Thus, specific treatment strategy for intracranial aneurysms in the elderly has been developed. Materials and Methods: Analysis of medical records, office charts, and imaging studies of all elderly patients who underwent surgical treatment of intracerebral aneurysms, and review of literature. Data related to these patients, like gender, aneurysm location, rupture, and comorbidities, were recorded. Results: Between June 1996 and November 2009, among 152 patients with 209 ruptured and unruptured intracranial aneurysms treated surgically, 23 patients were 65 years of age or older. Discussion: Withholding aneurysm surgery merely because of the patient’s age is not necessarily the most appropriate decision. Early surgery, in order to avoid re-rupture, vasospasm and infection, still is the better decision, independently of the treatment modality - open surgery or endovascular.

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“…Actually, they are treated in acute phase with good outcomes in the majority of patients 4 and the results depend on to their preoperative clinical condition. 1,14 .…”

Section: Surgical Proceduresmentioning

confidence: 99%

Surgical Treatment of Intracranial Aneurysms in Elderly

Aguiar¹,

Zicarelli²,

Melgar³

et al. 2018

jbnc

View full text Add to dashboard Cite

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“…Despite the lack of information of good quality (no RCTs specifically designed for this age group, very few elderly patients included in RCTs of SAH treatment, no matched or stratified case-control studies) [33,52,67,82,88], the available evidence of case-series from centres in different world regions indicates that both surgical repair and endovascular treatment are feasible in this age group with acceptable rates of morbidity. Elderly patients more likely to benefit are those in good condition prior to the intervention [33, 52, 66].…”

Section: Elderly Patientsmentioning

confidence: 99%

Update on subarachnoid haemorrhage

2008

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Subarachnoid haemorrhage (SAH) is less frequent than ischaemic stroke or intracerebral haemorrhage, but has a high public health relevance because it can affect young and middle-age adults, has considerable mortality and morbidity, it is treatable and preventable. SAH is traditionally a topic for neurosurgeons. However as endovascular interventions are becoming effective alternatives to surgical treatment, SAH should turn out to be of interest to neurologists, in particular to those devoted to stroke, emergency and neurointensive care. Despite stable incidence, the mortality of SAH has decreased in the last two decades due to better neurosurgical techniques and neurocritical care and to advances in interventional neuroradiological procedures. We review the recent advances in the clinical and diagnostic aspects of SAH and in the genetics of intracranial aneurysms. A systematic review of the treatment of SAH and grading of the available evidence is included.

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“…2 Age has an independent negative influence on the outcome. 3 The condition is common in the elderly compared to the younger population due to parenchymal atrophy, which allows a large quantity of blood to collect after aneurysm rupture. 3 This accounts for 5% of all acute strokes.…”

Section: Introductionmentioning

confidence: 99%

“…3 The condition is common in the elderly compared to the younger population due to parenchymal atrophy, which allows a large quantity of blood to collect after aneurysm rupture. 3 This accounts for 5% of all acute strokes. 3 Mortality rates as high as 45% have also been reported.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

Al-Mirza

Al-Taei

Al‐Saadi

2021

Int Clin Neurosci J

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Background: The aging of the healthy population without severe morbidity exposes them to cerebrovascular diseases and demand effective management. This study aimed to study the prevalence of geriatric cerebrovascular neurosurgical conditions in the Neurosurgical Department at Khoula Hospital, Muscat, Sultanate of Oman. Methods: A retrospective chart review of was done on geriatric cases admitted to the Neurosurgery Department in Khoula Hospital as an example of a neurosurgical center in a high-income developing country from January 2016 to 31st December 2019. Patients’ demographics, risk factors, diagnosis, Glasgow Coma Scale (GCS) on arrival, medications used, and length of stay were recorded. Results: 109 patients aged over 65 years were recruited in our retrospective review with a mean age of 74.12 years. Male-to-female ratio was (1.2:1). Intracerebral hemorrhage (ICH) was the most common vascular diagnosis (39.0%) followed by subarachnoid hemorrhage (SAH) (22.9%). Most patients (41.9%) had a GCS score of less than 8. About one-fifth of the patients received antiplatelet and anticoagulant medications. Most of the patients underwent surgical intervention (61.9%). 59% of the patients stayed in the hospital for less than 15 days. There were significant associations between the length of stay, treatment types (surgical vs. conservative), and age (P<0.05). Conclusion: Cerebrovascular pathologies are a growing cause of mortality and morbidity worldwide including developing countries because of the increasing number of elderly people. Antiplatelet medication and anticoagulants should be used with caution in the elderly.

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Ruptured Intracranial Aneurysms in the Elderly: Epidemiology, Diagnosis, and Management

Cited by 18 publications

References 66 publications

Surgical Treatment of Intracranial Aneurysms in Elderly

Surgical Treatment of Intracranial Aneurysms in Elderly

Update on subarachnoid haemorrhage

Geriatric Cerebrovascular Neurosurgery: Institutional Experience from Khoula Hospital

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