Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Benefits of Surgical Treatment for Unruptured Intracranial Aneurysms in Elderly Patients

  • Jang, E-Wook (Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jung, Jin-Young (Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hong, Chang-Ki (Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Joo, Jin-Yang (Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2010.10.26
  • Accepted : 2011.01.07
  • Published : 2011.01.28
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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 affects 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%) underwent clipping treatment, 25 (23%) patients were treated with coiling, and 28 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. Factors such as hypertension, diabetes mellitus, hypercholesterolemia, smoking, and family history of stroke were correlated with unfavorable outcomes. Two in the observation group refused follow-up and died of intracranial ruptured aneurysms. The observation group had a 7% mortality rate. Conclusion: Our results show acceptable favorable outcome of treatment-related 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.

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References

  1. Carter BS, Sheth S, Chang E, Sethl M, Oglivy CS : Epidemiology of the size distribution of intracranial bifurcation aneurysms : smaller size of distal aneurysms and increasing size of unruptured aneurysms with age. Neurosurgery 58 : 217-223; discussion 217-223, 2006 https://doi.org/10.1227/01.NEU.0000194639.37803.F8
  2. de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ : Incidence of subarachnoid haemorrhage : a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78 : 1365-1372, 2007 https://doi.org/10.1136/jnnp.2007.117655
  3. Headache Classification Subcommittee of the international Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 24 : 9-160, 2004
  4. Higashida RT, Lahue BJ, Torbey MT, Hopkins LN, Leip E, Hanley DF : Treatment of unruptured intracranial aneurysms : a nationwide assessment of effectiveness. AJNR Am J Neuroradiol 28 : 146-151, 2007
  5. Hoh BL, Sistrom CL, Firment CS, Fautheree GL, Velat GJ, Whiting JH, et al. : Bottleneck factor and height-width ratio : association with ruptured aneurysms in patients with multiple cerebral aneurysms. Neurosurgery 61 : 716-722; discussion 722-723, 2007 https://doi.org/10.1227/01.NEU.0000298899.77097.BF
  6. Inagawa T : Management outcome in the elderly patient following subarachnoid hemorrhage. J Neurosurg 78 : 554-561, 1993 https://doi.org/10.3171/jns.1993.78.4.0554
  7. Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, et al. : Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama study. Stroke 30 : 1390-1395, 1999 https://doi.org/10.1161/01.STR.30.7.1390
  8. Johnston SC, Higashida RT, Barrow DL, Caplan LR, Dion JE, Hademenos G, et al. : Recommendations for the endovascular treatment of intracranial aneurysms : a statement for healthcare professionals from the Committee on Cerebrovascular Imaging of the American Heart Association Council on Cardiovascular Radiology. Stroke 33 : 2536-2544, 2002 https://doi.org/10.1161/01.STR.0000034708.66191.7D
  9. Juvela S, Porras M, Poussa K : Natural history of unruptured intracranial aneurysms : probability of and risk factors for aneurysm rupture. J Neurosurg 93 : 379-387, 2000 https://doi.org/10.3171/jns.2000.93.3.0379
  10. Kim JE, Lim DJ, Hong CK, Joo SP, Yoon SM, Kim BT : Treatment of unruptured intracranial aneurysms in South Korea in 2006 : a nationwide multicenter survey form the Korean Society of Cerebrovascular Surgery. J Korean Neurosurg Soc 47 : 112-118, 2010 https://doi.org/10.3340/jkns.2010.47.2.112
  11. Krisht AF, Gomez J, Partington S : Outcome of surgical clipping of unruptured aneurysms as it compares with a 10-year nonclipping survival period. Neurosurgery 58 : 207-216; discussion 207-216, 2006 https://doi.org/10.1227/01.NEU.0000194638.61073.FC
  12. Lanterna LA, Tredici G, Dimitrov BD, Biroli F : Treatment of unruptured cerebral aneurysms by embolization with guglielmi detachable coils : case-fatality, morbidity, and effectiveness in preventing bleeding-- a systematic review of the literature. Neurosurgery 55 : 767-775; discussion 775-778, 2004 https://doi.org/10.1227/01.NEU.0000137653.93173.1C
  13. Phillips LH 2nd, Whisnant JP, O'Fallon WM, Sundt TM Jr : The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30 : 1034-1040, 1980 https://doi.org/10.1212/WNL.30.10.1034
  14. Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ : Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics. Stroke 38 : 1404-1410, 2007 https://doi.org/10.1161/01.STR.0000260955.51401.cd
  15. Moroi J, Hadeishi H, Suzuki A, Yasui N : Morbidity and mortality from surgical treatment of unruptured cerebral aneurysms at Research Institute for Brain and Blood Vessels-Akita. Neurosurgery 56 : 224-231; discussion 224-231, 2005 https://doi.org/10.1227/01.NEU.0000148897.28828.85
  16. Ogilvy CS, Carter BS : Stratification of outcome for surgically treated unruptured intracranial aneurysms. Neurosurgery 52 : 82-87; discussion 87-88, 2003
  17. Raaymakers TW, Rinkel GJ, Limburg M, Algra A : Mortality and morbidity of surgery for unruptured intracranial aneurysms : a meta-analysis. Stroke 29 : 1531-1538, 1998 https://doi.org/10.1161/01.STR.29.8.1531
  18. Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamargo RJ. : Microsurgical clipping and endovascular coiling of intracranial aneurysms : a critical review of the literature. Neurosurgery 62 : 1187-1202; discussion 1202-1203, 2008 https://doi.org/10.1227/01.neu.0000333291.67362.0b
  19. Rinkel G, Djibuti M, Algra A, van Gijn J : Prevalence and risk of rupture of intracranial aneurysms : a systematic review. Stroke 29 : 251-256, 1998 https://doi.org/10.1161/01.STR.29.1.251
  20. Ronkainen A, Miettinen H, Karkola K, Papinaho S, Vanninen R, Puranen M, et al. : Risk of harboring an unruptured intracranial aneurysm. Stroke 29 : 359-362, 1998 https://doi.org/10.1161/01.STR.29.2.359
  21. Sekhar LN, Heros RC : Origin, growth, and rupture of saccular aneurysms : a review. Neurosurgery 8 : 248-260, 1981 https://doi.org/10.1227/00006123-198102000-00020
  22. Suyama K, Kaminogo M, Yonekura M, Baba H, Nagata I : Surgical treatment of unruptured cerebral aneurysms in the elderly. Acta Neurochir Suppl 94 : 97-101, 2005
  23. Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, et al. : Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms : a possible index for surgical treatment of intracranial aneurysms. Neurosurgery 45 : 119-129; discussion 129-130, 1999 https://doi.org/10.1097/00006123-199907000-00028
  24. Ujiie H, Tamano Y, Sasaki K, Hori T : Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm? Neurosurgery 48 : 495-502; discussion 502-503, 2001 https://doi.org/10.1097/00006123-200103000-00007
  25. Wardlaw JM, White PM : The detection and management of unruptured intracranial aneurysms. Brain 123 : 205-221,2000 https://doi.org/10.1093/brain/123.2.205
  26. Waters WE, O'Connor PJ : Epidemiology of headache and migraine in women. J Neurol Neurosurg Psychiatry 34 : 148-153, 1971 https://doi.org/10.1136/jnnp.34.2.148
  27. Yamashita K, Kashiwagi S, Kato S, Takasago T, Ito H : Cerebral aneurysms in the elderly in Yamaguchi, Japan. Analysis of the Yamaguchi Data Bank of Cerebral Aneurysm from 1985 to 1995. Stroke 28 : 1926-1931, 1997 https://doi.org/10.1161/01.STR.28.10.1926

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