Treatment and Outcomes of the Patients over the Age of 80 with Ruptured Aneurysmal Subarachnoid Hemorrhage

The prognosis and the best treatment strategies of the elderly patients with ruptured aneurysmal subarachnoid hemorrhage are unclear. We retrospectively analyzed 21 patients over the age of 80 in comparison with 139 patients younger than 80. The patients over 80 years old had significantly worse clinical presentation representing World Federation of Neurosurgical Societies Grade IV and V, significant predilection of conservative treatment and significantly worse clinical outcomes representing modified Rankin Scale 4 or more. Clinical outcomes were significantly worse even in the case of the good grade patients such as World Federation of Neurosurgical Societies Grade I/II/III. Surgical interventions did not bring better outcomes. The choice of the surgical interventions between direct surgery and endovascular treatment did not affect the outcomes of the patients. The patients of the ruptured aneurysmal subarachnoid hemorrhage over the age of 80 presented poorer grade and showed worse outcomes unrelated to the presenting grade than those of a younger age. There may be non-neurosurgical reasons affecting the outcomes in the elderly such as the emergency nature of the disease itself and the longer duration of the surgical intervention. The choice of treatment should depend not only on the neurosurgical conditions but also on the anatomical backgrounds relating to the surgical approaches and the general status.