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고령군 뇌동맥류 환자의 치료

Other Titles
 Management of elderly patients with intracranial aneurysm 
Authors
 박현선  ;  이재환  ;  김진영  ;  신용삼  ;  주진양  ;  허승곤  ;  이규창 
Citation
 Journal of Korean Neurosurgical Society (대한신경외과학회지), Vol.29(6) : 786-793, 2000 
Journal Title
 Journal of Korean Neurosurgical Society (대한신경외과학회지) 
ISSN
 1225-8245 
Issue Date
2000
Keywords
Elderly patients ; Intracranial aneurysm ; Management ; Surgical results
Abstract
Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.
Files in This Item:
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Jae Whan(이재환)
Joo, Jin Yang(주진양)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/172211
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