Skip to main content
SpringerLink
Log in

A Restriction for the Surgical or Endovascular Treatment of a Ruptured Aneurysm in the Elderly?

  • Chapter
  • First Online:
Evidence for Neurosurgery

  • 410 Accesses

Abstract

Aneurysm treatment with clipping or coiling is indicated to prevent aneurysm re-rupture after aneurysmal subarachnoid hemorrhage (SAH). Any form of benefit of treatment requires active treatment to improve on natural history of the aneurysm. Primarily, morbidity and mortality of aneurysm treatment need to be lower than morbidity from re-rupture. For ruptured aneurysms, the risk of re-rupture within 6 months was reported at 40% for patients of all ages with a mortality of 78% [1]; and not less for elderly patients. Next to effects of initial bleeding, historical materials cite re-bleeding and surgical complications as main determinants of a bad outcome [2]. For subarachnoid hemorrhage, high age appears to increase treatment risk [3]. The highest mortality was seen in poor-grade patients over 75 who, however, were treated conservatively [4]. In addition, the expected remaining life-time for the age must be considered to assess potential benefit of preventing re-rupture, since competing risks are higher at a higher age. In contrast, several studies report favorable outcome after more aggressive management of aneurysms in an elderly population [5, 6].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Nishioka H, Torner JC, Graf CJ, Kassell NF, Sahs AL, Goettler LC. Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively. Arch Neurol. 1984;41:1142–6.

    Article  CAS  PubMed  Google Scholar 

  2. Saveland H, Brandt L. Which are the major determinants for outcome in aneurysmal subarachnoid hemorrhage? A prospective total management study from a strictly unselected series. Acta Neurol Scand. 1994;90:245–50.

    Article  CAS  PubMed  Google Scholar 

  3. Goldberg J, Schoeni D, Mordasini P, Z’Graggen W, Gralla J, Raabe A, et al. Survival and outcome after poor-grade aneurysmal subarachnoid hemorrhage in elderly patients. Stroke. 2018;49:2883–9. https://doi.org/10.1161/STROKEAHA.118.022869.

    Article  PubMed  Google Scholar 

  4. Nieuwkamp DJ, Rinkel GJE, Silva R, Greebe P, Schokking DA, Ferro JM. Subarachnoid haemorrhage in patients > or = 75 years: clinical course, treatment and outcome. J Neurol Neurosurg Psychiatry. 2006;77:933–7. https://doi.org/10.1136/jnnp.2005.084350.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Johansson M, Cesarini KG, Contant CF, Persson L, Enblad P. Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage. Stroke. 2001;32:2845–949.

    Article  CAS  PubMed  Google Scholar 

  6. Suzuki Y, Watanabe A, Wakui K, Horiuchi T, Hongo K. Results of clipping surgery for aneurysmal subarachnoid hemorrhage in elderly patients aged 90 or older. Acta Neurochir Suppl. 2016;123:13–6. https://doi.org/10.1007/978-3-319-29887-0_2.

    Article  PubMed  Google Scholar 

  7. Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med. 1999;18:2693–708.

    Article  CAS  PubMed  Google Scholar 

  8. Viechtbauer W. Bias and efficiency of meta-analytic variance estimators in the random- effects model. J Educ Behav Stat. 2005;30:261–93. https://doi.org/10.3102/10769986030003261.

    Article  Google Scholar 

  9. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48.

    Article  Google Scholar 

  11. Duan G, Yang P, Li Q, Zuo Q, Zhang L, Hong B, et al. Prognosis predicting score for endovascular treatment of aneurysmal subarachnoid hemorrhage: a risk modeling study for individual elderly patients. Medicine (Baltimore). 2016;95:e2686. https://doi.org/10.1097/MD.0000000000002686.

    Article  CAS  Google Scholar 

  12. Sedat J, Dib M, Lonjon M, Litrico S, Von Langsdorf D, Fontaine D, et al. Endovascular treatment of ruptured intracranial aneurysms in patients aged 65 years and older: follow-up of 52 patients after 1 year. Stroke. 2002;33:2620–5.

    Article  CAS  PubMed  Google Scholar 

  13. Johansson M, Norback O, Gal G, Cesarini KG, Tovi M, Solander S, et al. Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage. Neuroradiology. 2004;46:385–91. https://doi.org/10.1007/s00234-004-1170-x.

    Article  CAS  PubMed  Google Scholar 

  14. Watanabe D, Hashimoto T, Koyama S, Ohashi HT, Okada H, Ichimasu N, et al. Endovascular treatment of ruptured intracranial aneurysms in patients 70 years of age and older. Surg Neurol Int. 2014;5:104. https://doi.org/10.4103/2152-7806.136090.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gu D-Q, Zhang X, Luo B, Long X-A, Duan C-Z. Impact of ultra-early coiling on clinical outcome after aneurysmal subarachnoid hemorrhage in elderly patients. Acad Radiol. 2012;19:3–7. https://doi.org/10.1016/j.acra.2011.09.012.

    Article  PubMed  Google Scholar 

  16. Karamanakos PN, Koivisto T, Vanninen R, Khallaf M, Ronkainen A, Parviainen I, et al. The impact of endovascular management on the outcome of aneurysmal subarachnoid hemorrhage in the elderly in eastern Finland. Acta Neurochir. 2010;152:1493–502. https://doi.org/10.1007/s00701-010-0714-6.

    Article  PubMed  Google Scholar 

  17. Bekelis K, Gottlieb D, Su Y, O’Malley AJ, Labropoulos N, Goodney P, et al. Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage. J Neurointerv Surg. 2016;8:913–8. https://doi.org/10.1136/neurintsurg-2015-011890.

    Article  PubMed  Google Scholar 

  18. Proust F, Gerardin E, Derrey S, Lesveque S, Ramos S, Langlois O, et al. Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients. J Neurosurg. 2010;112:1200–7. https://doi.org/10.3171/2009.10.JNS08754.

    Article  PubMed  Google Scholar 

  19. Park J, Woo H, Kang D-H, Kim Y. Critical age affecting 1-year functional outcome in elderly patients aged >/= 70 years with aneurysmal subarachnoid hemorrhage. Acta Neurochir. 2014;156:1655–61. https://doi.org/10.1007/s00701-014-2133-6.

    Article  PubMed  Google Scholar 

  20. Iosif C, Di Maria F, Sourour N, Degos V, Bonneville F, Biondi A, et al. Is a high initial World Federation of Neurosurgery (WFNS) grade really associated with a poor clinical outcome in elderly patients with ruptured intracranial aneurysms treated with coiling? J Neurointerv Surg. 2014;6:286–90. https://doi.org/10.1136/neurintsurg-2013-010711.

    Article  PubMed  Google Scholar 

  21. Jain R, Deveikis J, Thompson BG. Endovascular management of poor-grade aneurysmal subarachnoid hemorrhage in the geriatric population. AJNR Am J Neuroradiol. 2004;25:596–600.

    PubMed  PubMed Central  Google Scholar 

  22. Luo C-B, Teng MM-H, Chang F-C, Chang C-Y. Endovascular embolization of ruptured cerebral aneurysms in patients older than 70 years. J Clin Neurosci. 2007;14:127–32. https://doi.org/10.1016/j.jocn.2006.05.018.

    Article  PubMed  Google Scholar 

  23. Horiuchi T, Tanaka Y, Hongo K. Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery. 2005;56:469–75.

    Article  PubMed  Google Scholar 

  24. Horiuchi T, Tsutsumi K, Ito K, Hongo K. Results of clipping surgery for aneurysmal subarachnoid hemorrhage in the ninth and tenth decades of life. J Clin Neurosci. 2014;21:1567–9. https://doi.org/10.1016/j.jocn.2013.11.047.

    Article  PubMed  Google Scholar 

  25. Dasenbrock H, Gormley WB, Lee Y, Mor V, Mitchell SL, Fehnel CR. Long-term outcomes among octogenarians with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2018;1:1–12. https://doi.org/10.3171/2018.3.JNS173057.

    Article  Google Scholar 

  26. Zheng K, Zhao B, Tan X-X, Li Z-Q, Xiong Y, Zhong M, et al. Comparison of aggressive surgical treatment and palliative treatment in elderly patients with poor-grade intracranial aneurysmal subarachnoid hemorrhage. Biomed Res Int. 2018;2018:5818937. https://doi.org/10.1155/2018/5818937.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wilson TJ, Davis MC, Stetler WR, Giles DA, Chaudhary N, Gemmete JJ, et al. Endovascular treatment for aneurysmal subarachnoid hemorrhage in the ninth decade of life and beyond. J Neurointerv Surg. 2014;6:175–7. https://doi.org/10.1136/neurintsurg-2013-010714.

    Article  PubMed  Google Scholar 

  28. Silva NA, Shao B, Sylvester MJ, Eloy JA, Gandhi CD. Unruptured aneurysms in the elderly: perioperative outcomes and cost analysis of endovascular coiling and surgical clipping. Neurosurg Focus. 2018;44:E4. https://doi.org/10.3171/2018.1.FOCUS17714.

    Article  PubMed  Google Scholar 

  29. Brinjikji W, Lanzino G, Rabinstein AA, Kallmes DF, Cloft HJ. Age-related trends in the treatment and outcomes of ruptured cerebral aneurysms: a study of the nationwide inpatient sample 2001-2009. AJNR Am J Neuroradiol. 2013;34:1022–7. https://doi.org/10.3174/ajnr.A3321.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Barker FG 2nd, Amin-Hanjani S, Butler WE, Hoh BL, Rabinov JD, Pryor JC, et al. Age- dependent differences in short-term outcome after surgical or endovascular treatment of unruptured intracranial aneurysms in the United States, 1996-2000. Neurosurgery. 2004;54:18–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Copenhagen, Copenhagen, Denmark

    Christian Mirian & Tiit Mathiesen

Authors
  1. Christian Mirian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tiit Mathiesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tiit Mathiesen .

Editor information

Editors and Affiliations

  1. Radboud University Medical Center, Nijmegen, The Netherlands

    Ronald H. M. A. Bartels

  2. Radboud University Medical Center, Nijmegen, The Netherlands

    Maroeska M. Rovers

  3. Radboud University Medical Center, Nijmegen, The Netherlands

    Gert P. Westert

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mirian, C., Mathiesen, T. (2019). A Restriction for the Surgical or Endovascular Treatment of a Ruptured Aneurysm in the Elderly?. In: Bartels, R., Rovers, M., Westert, G. (eds) Evidence for Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-16323-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16323-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16322-8

  • Online ISBN: 978-3-030-16323-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation