Výsledky léčby aneuryzmatického subarachnoidálního krvácení u seniorů
| Title in English | Results of treatment of aneurysmal subarachnoid hemorrhage in the elderly |
|---|---|
| Authors | |
| Year of publication | 2023 |
| Type | Article in Periodical |
| Magazine / Source | Česká a slovenská neurologie a neurochirurgie |
| MU Faculty or unit | |
| Citation | |
| Web | https://www.prolekare.cz/en/journals/czech-and-slovak-neurology-and-neurosurgery/2023-4-7/vysledky-lecby-aneuryzmatickeho-subarachnoidalniho-krvaceni-u-senioru-135142 |
| Doi | http://dx.doi.org/10.48095/cccsnn2023256 |
| Keywords | clipping; seniors; subarachnoid hemorrhage; coiling |
| Description | Introduction: The aim of our study is to present the treatment outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) 3 months after the attack who were treated with clipping (MS) or coiling (EV). Materials and methods: The study was based on a retrospective analysis of a database of patients with cerebral aneurysms who were treated at the University Hospital Brno between 2009 and 2019. A total of 499 patients were included in the study. Of these patients, 345 (69%) were treated with surgical MS and 154 (31%) were treated with EV. Patients were divided into 4 groups: according to the age into 0–64 years and 65+ years group, and according to the modality of treatment of aneurysm by MS or EV. We evaluated the effect of the initial Hunt-Hess (HH) score on the treatment outcome according to age and modality and also the relationship between the current age of the patient and the treatment outcome at 3 months after the SAH attack, as assessed by a modified Rankin scale (mRS), where the successful treatment outcome was mRS 0–2 (self-sufficient patient), and the effect of the initial Hunt-Hess score (HH) on the treatment outcome was based on age and modality. Results: Of the 499 patients, 345 (69%) were treated with MS and 154 (31%) with EV, and the average age of MS and EV treated patients was not statistically significantly different (P = 0.2216). In both surgically and endovascularly treated patients in all age categories; we did not observe a statistically significant difference in HH score (P = 0.1664) or in graphical severity of SAH according to the Fischer score (P = 0.5041). Satisfactory treatment outcome (mRS 0–2) at 3 months after the attack was found in 49 (52.88%) in the 65+ years group after MS and 23 (60.61%) in the 65+ years group after EV. Poor treatment outcome (mRS 3–6) at 3 months was found in 43 (47.12%) in MS treated and 15 (39.39%) in EV treated patients, which was statistically significant (P = 0.0002). Satisfactory treatment outcome (mRS 0–2) at 3 months with good clinical status on admission (HH 1–2) was seen in 136 (55%) patients in the 0–64 years group after MS and 28 (33%) in the 65+ years group after MS. Poor treatment outcome (mRS 3–6) after 3 months with poor initial clinical condition (HH 3–5) had 50 (20%) patients treated with MS in the 0 -64 years group and 39 (44%) treated with MS in the 65+ years group, which is statistically significant (P = 0.0001). Conclusion: Elderly (65+ years) after SAH are at a higher risk of poor neurological status 3 months after the attack compared to younger patients, especially if they are in a severe clinical condition on admission. However, a significant proportion of these patients remain in a good clinical condition after treatment of an aneurysm, so the method of treatment and extent of treatment needs to be assessed individually. In elderly patients treated endovascularly, we observed a better treatment outcome at 3 months compared with patients treated by open surgery. |