Analysis of the surgical outcome of unruptured intracranial saccular aneurysms in octogenarians (80–89 Years)

Binoy Thavara; Yasuhiro Yamada; Girish Joshi; Riki Tanaka; Kyosuke Miyatani; Gowtham Devareddy; Kazutaka Nakao; Tsukasa Kawase; Yoko Kato

doi:10.4103/ajns.AJNS_44_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 640-643
DOI: 10.4103/ajns.AJNS_44_20

Original Article

Analysis of the surgical outcome of unruptured intracranial saccular aneurysms in octogenarians (80–89 Years)

Binoy Thavara

¹Department of Neurosurgery, Government Medical College, Thrissur, Kerala

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

,

Yasuhiro Yamada

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

,

Girish Joshi

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

³Department of Neurosurgery, Apollo Speciality Hospital, Bengaluru, Karnataka, India

,

Riki Tanaka

¹Department of Neurosurgery, Government Medical College, Thrissur, Kerala

,

Kyosuke Miyatani

¹Department of Neurosurgery, Government Medical College, Thrissur, Kerala

,

Gowtham Devareddy

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

⁴Department of Neurosurgery, Dr. Rela Institute and Medical Centre, Chennai, Tamil Nadu, India

,

Kazutaka Nakao

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

,

Tsukasa Kawase

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

,

Yoko Kato

²Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan

› Author Affiliations

Abstract

Background: The prevalence of unruptured intracranial aneurysms is increasing in elderly population in Japan. Octogenarians (80–89 years) are more prone to complications due to increased age, comorbidities, increased risk of vasospasm, and treatment risks. Aim: The aim is to study the surgical outcome of unruptured intracranial saccular aneurysms in elderly patients aged between 80 and 89 years. Patients and Methods: A retrospective study was conducted involving all the cases of unruptured intracranial saccular aneurysms operated surgically in elderly patients aged between 80 and 89 years. All the cases operated between January 2017 and October 2019 were included in the study. The preoperative neurological status was assessed using the Glasgow Coma Scale (GCS). The comorbidities and risk factors involved were assessed. Postoperative neurological status was assessed by (1) postoperative GCS score and by the (2) presence or absence of the motor weakness of limbs. Results: Thirty-three aneurysms were operated in 27 patients. Two patients were operated two times at separate occasions for different aneurysms during the study period and hence making a total of 29 surgeries. The age range was 80–88 years, with a mean of 82.4 years ± 2.64 standard deviation (SD). There were 7 (24.1%) males and 22 (75.86%) females. All the patients had a preoperative GCS score of 15/15 without focal neurological deficit. The mean size (mm) of the aneurysms was 6.57 ± 4.04 SD. There were 31 (93.94%) aneurysms in the anterior circulation and 2 (6.06%) aneurysms in the posterior circulation. The comorbidities and risk factors were analyzed and found to be not influencing the outcome of the patients. Clipping was done in 32 aneurysms. One case of posterior inferior cerebellar artery (PICA) aneurysm underwent occipital artery to PICA bypass surgery. The postoperative complications include chronic subdural hematoma (CSDH) in 7 (24.13%) patients, extradural hematoma in 1 (3.4%), meningitis in 1 (3.4%), and lower cranial nerve palsy in 1 (3.4%) patient. All the patients were discharged with GCS score 15/15 without motor weakness of the limbs. The mean duration of stay was 16.62 days ± 9.98 SD. Conclusion: Surgery for unruptured saccular aneurysms in octogenarians has got a good result in the tertiary care facility. Advanced age alone should not be considered for preferring coiling over clipping. Octogenarians are more prone to developing postoperative CSDH.

Key-words:

Aneurysm - clipping - octogenarian - unruptured intracranial aneurysms

Full Text

References

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