Clinical Outcome of Elderly Patients with Subarachnoid Hemorrhage: Validation of Modality Assignment Based on Aneurysmal Morphology and Location

Abstract

Background: The number of elderly patients with subarachnoid hemorrhage is increasing. Elderly patients have been postulated to benefit more from endovascular coiling, compared with neurosurgical clipping. However, we based our therapeutic modality on the morphology and location of the aneurysms, rather than patients' age or their World Federation of Neurological Surgeons grade. The aim of this study was to investigate the validity of our therapeutic modality over earlier approaches by assessing their clinical outcomes.

Methods: The study sample included 539 patients who underwent surgical procedures between January 2010 and May 2019. Baseline characteristics, aneurysmal morphology and location, surgical and clinical complications, and clinical outcomes were compared between elderly (defined as aged 75 years or older) and young patients.

Results: There were 124 elderly patients (23.0%) in the sample. Eighty-five elderly patients (68.5%) received neurosurgical clipping, whereas 67.0% of the young patients (P = 0.827) received neurosurgical clipping. Of the elderly patients who had a poor World Federation of Neurological Surgeons grade, 49.4% and 48.7% underwent neurosurgical clipping and endovascular coiling, respectively (P = 1.000). Elderly patients had fewer favorable outcomes (21.8%) relative to young patients (61.8%; P < 0.001). There were no significant differences in the rate of favorable outcomes between patients undergoing neurosurgical clipping relative to endovascular coiling (21.2% vs. 23.1%; P = 0.818).

Conclusions: Neurosurgical clipping and endovascular coiling yield comparable clinical outcomes in elderly and young patients with subarachnoid hemorrhage. These findings indicate that using a therapeutic modality based on aneurysmal morphology and location may be an effective treatment approach.

Keywords: Aneurysmal morphology; Elderly patients; Endovascular coiling; Neurosurgical clipping; Subarachnoid hemorrhage (SAH).