Surgical and endovascular treatment for elderly patients with ruptured intracranial aneurysm

Objective To observe the efficacy of craniotomy and endovascular embolization in for elderly patients with intracranial aneurysm. Methods Seventy-four patients (aged older than 65 years) with ruptured aneurysm were selected, and they were divided into craniotomy group (n=26) and endovascular embolization group (n=48). Their postoperative complications and the results Glasgow outcome scale (GOS) score were evaluated at discharge. The telephone and Outpatient Department follow-up period lasted for 6 months to 4 years. Results Ten patients presented with symptomatic vasospasm after operation in the craniotomy group; 5 patients had ventriculoperitoneal shunt because of hydrocephalus, 2 patients died because of delayed cerebral infarction, cerebral edema and herniation. Nineteen patients had better outcomes based on GOS score at discharge, 5 had poorer outcomes, and 2 died. Seventeen patients had symptomatic vasospasm in the endovascular embolization group; 5 had ventriculoperitoneal shunt because of hydrocephalus; 3 died, 2 of them die of delayed vasospastic cerebral ischemia and pulmonary infection, the other died of large cerebral infarction caused by middle cerebral artery occlusion that resulted from coil herniation. Thirty-three patients had better outcomes based on GOS score at discharge, 12 had poorer outcomes, and 3 died. There was no significant difference in GOS between the 2 groups. Conclusion The clinical efficacy between the craniotomy and the endovascular embolization was similar. However, because of endovascular embolization is minimally; it should be the first choice in the treatment of aneurysm in older patients. In addition, the incidence of postoperative delayed vasospasm is higher in older patients with aneurysm after being treated with the 2 therapeutic approaches. Therefore, a great attention should be paid to it.