Treatment of unruptured intracranial aneurysms in the elderly patients

Abstract

Objective: Due to longer life spans, patients newly diagnosed with unruptured intracranial aneurysms (UIAs) are increasing in number. This study aimed to evaluate how management of UIAs in patients age 65 years and older affect the clinical outcomes and post-procedural morbidity rates in these patients.Methods: We retrospectively reviewed 109 patients harboring 136 aneurysms across 12 years, between 1997 and 2009, at our institute. We obtained the following data from all patients: age, sex, location and size of the aneurysm(s), presence of symptoms, risk factors for stroke, treatment modality, and postoperative 1-year morbidity and mortality. We classified these patients into three groups: Group A (surgical clipping), Group B (coil embolization), and Group C (observation only).Results: Among the 109 patients, 56 (51.4%) received clipping treatment, 25 (23%) received coiling, and 28 received observation only. The overall morbidity and mortality rates were 2.46% and 0%, respectively. The morbidity rate was 1.78% for clipping and 4% for coiling. Unfavorable outcomes correlated to these factors: hypertension, diabetes mellitus , hypercholesterolemia, smoking, and family history of stroke. Two in the observation group refused follow-up and died of ruptured subarachnoid hemorrhage. The observation group had a 7% mortality rate.Conclusion: Our results showed acceptable favorable outcome of treatment-morbidity comparing with the natural history of unruptured cerebral aneurysm. Surgical clipping did not lead to inferior outcomes in our study, although coil embolization is generally more popular for treating elderly patients. In the treatment of patients more than 65 years old, age is not the limiting factor.