Treatment and Outcomes in Elderly Patients with Cerebral Aneurysms and Subarachnoid Hemorrhages Using an Integrated Team Approach

Methods A prospective inpatient neurosurgery database(2006-2010)at a communitybased,tertiary care neuro-intensive care unit was reviewed for patients admitted with:subarachnoid hemorrhage or cerebral aneurysm. Results Out of 365 patients,one hundred and ten patients (30%)were 65 y old or older(mean 73.8 y; s.d. 7.24,range 65 -93).Patients were grouped based on presence of subarachnoid hemorrhage (N=25; Y=85). All 25 patients with unruptured cerebral aneurysms survived their initial hospitalization and returned home.Of the 85 seniors with subarachnoid hemorrhage, 61 survived hospitalization(72%)and 24 expired (28%). Among survivors, 39 were discharged home (64%%) and 22 to a subacute facility (36%). Initial Hunt Hess Grade strongly predicted survival of the hospitalization [HH 2-3: 43/44 (98%); HH 4-5: 18/41 (44%)]. Aneurysmal bleeding was diagnosed 55 patients (65%), non-aneurysmal causes in 9 (10%), and no etiology in 21 (25%). Aneurysms were treated with surgical clipping in 15/39 patients and endovascular methods in 24/39. Due to poor clinical grade, treatment was not pursued in 16 aneurysms. Multiple aneurysms were found in 17/55 patients (31%). External ventriculostomy was performed in 33 patients (39%) and ventriculoperitoneal shunting were placed in 5 (5/33; 15%). Symptomatic cerebral vasospasm occurred in 7 (8%).