Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제12권3호
  • /
  • Pages.190-195
  • /
  • 2010
  • /
  • 2234-8565(pISSN)
  • /
  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
권호 표지

고연령군 뇌동맥류 파열 환자의 치료 결과

Treatment Outcome of Ruptured Cerebral Aneurysms in the Elderly

  • 윤기성 (인제대학교 의과대학 일산백병원 신경외과학교실) ;
  • 최찬영 (인제대학교 의과대학 일산백병원 신경외과학교실) ;
  • 한성록 (인제대학교 의과대학 일산백병원 신경외과학교실) ;
  • 이기택 (인제대학교 의과대학 일산백병원 신경외과학교실) ;
  • 손문준 (인제대학교 의과대학 일산백병원 신경외과학교실) ;
  • 이채혁 (인제대학교 의과대학 일산백병원 신경외과학교실)
  • Yoon, Ki-Sung (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Choi, Chan-Young (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Han, Seong-Rok (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Yee, Gi-Taek (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Sohn, Moon-Jun (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Chae-Heuck (Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University)
  • 발행 : 2010.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : This study aimed to assess the results of surgical and endovascular treatments in aneurysmal subarachnoid hemorrhage (SAH) patients older than 70 years. Methods : This study included 18 patients, more than 70 years of age, treated for ruptured cerebral aneurysms between April 2004 and March 2009. In most cases, patients underwent the early obliteration procedure for each aneurysm, and we compared the clinical results according to the obliteration method (clipping or coiling). We assessed neurological outcomes at 6 months postprocedure according to the modified Rankin Scale (mRS): favorable (mRS score < 2) or unfavorable (mRS score < 2). Results : Of the 18 patients, 12 (66.6%) underwent obliteration of the aneurysm sac via microvascular clipping patients, and 6 (33.3%) underwent endovascular coiling. At 6 months post-procedure, the clinical outcomes were favorable in 6 patients (33.3%), 5 (41.7%) who received microvascular clipping and 1 (16.7%) who underwent endovascular coiling. Unfavorable outcome was not statistically associated with poor initial clinical state, poor Fisher grade, occurrence of stroke, or hydrocephalus, although we frequently noted these variables in the unfavorable outcomes. Conclusions : In this study, aneurysm obliteration method (microvascular clipping vs. endovascular coiling) did not seem to significantly affect clinical outcomes. A poor initial clinical state, poor Fisher grade, occurrence of stroke, and hydrocephalus seemed to be associated with poor clinical outcomes.

키워드

참고문헌

  1. Bradac GB, Bergui M,Fontanella M. Endovascular treatment of cerebral aneurysms in elderly patients. Neuroradiology 47:938-41, 2005 https://doi.org/10.1007/s00234-005-1444-y
  2. Brilstra EH, Rinkel GJ, Algra A,van Gijn J. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage. Neurology 55:1656-60, 2000 https://doi.org/10.1212/WNL.55.11.1656
  3. Cai Y, Spelle L, Wang H, Piotin M, Mounayer C, Vanzin JR, et al. Endovascular treatment of intracranial aneurysms in the elderly: single-center experience in 63 consecutive patients. Neurosurgery 57:1096-1102; discussion 1096-1102, 2005 https://doi.org/10.1227/01.NEU.0000185583.25420.DF
  4. Chung RY, Carter BS, Norbash A, Budzik R, Putnam C,Ogilvy CS. Management outcomes for ruptured and unruptured aneurysms in the elderly. Neurosurgery 47:827-32; discussion 832-3, 2000 https://doi.org/10.1097/00006123-200010000-00006
  5. de Rooij NK, Linn FH, van der Plas JA, Algra A,Rinkel GJ. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365-72, 2007 https://doi.org/10.1136/jnnp.2007.117655
  6. Dorai Z, Hynan LS, Kopitnik TA,Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 52:763-9; discussion 769-71, 2003 https://doi.org/10.1227/01.NEU.0000053222.74852.2D
  7. Ellington E,Margolis G. Block of arachnoid villus by subarachnoid hemorrhage. J Neurosurg 30:651-7, 1969 https://doi.org/10.3171/jns.1969.30.6.0651
  8. Ferch R, Pasqualin A, Barone G, Pinna G,Bricolo A. Surgical management of ruptured aneurysms in the eighth and ninth decades. Acta Neurochir (Wien) 145:439-45; discussion 445, 2003
  9. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1-9, 1980 https://doi.org/10.1227/00006123-198001000-00001
  10. Horiuchi T, Tanaka Y,Hongo K. Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery 56:469-75; discussion 469-75, 2005 https://doi.org/10.1227/01.NEU.0000153926.67713.B8
  11. Inagawa T. Cerebral vasospasm in elderly patients treated by early operation for ruptured intracranial aneurysms. Acta Neurochir (Wien) 115:79-85, 1992 https://doi.org/10.1007/BF01406362
  12. Laidlaw JD,Siu KH. Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age. J Neurosurg 97:250-8; discussion 247-59, 2002 https://doi.org/10.3171/jns.2002.97.2.0250
  13. Laidlaw JD, Siu KH. Aggressive surgical treatment of elderly patients following subarachnoid haemorrhage: management outcome results. Journal of Clinical Neuroscience 9:404-10, 2002 https://doi.org/10.1054/jocn.2002.1097
  14. Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 85:410-8, 1996 https://doi.org/10.3171/jns.1996.85.3.0410
  15. Le Roux PD, Elliott JP, Newell DW, Grady MS,Winn HR. Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 85:39-49, 1996 https://doi.org/10.3171/jns.1996.85.1.0039
  16. Lindvall P, Runnerstam M, Birgander R, Koskinen LO. The Fisher grading correlated to outcome in patients with subarachnoid haemorrhage. Br J Neurosurg 23:188-192, 2009 https://doi.org/10.1080/02688690802710668
  17. Lubicz B, Leclerc X, Gauvrit JY, Lejeune JP,Pruvo JP. Endovascular treatment of ruptured intracranial aneurysms in elderly people. AJNR Am J Neuroradiol 25:592-5, 2004
  18. McComb JG. Recent research into the nature of cerebrospinal fluid formation and absorption. Journal of neurosurgery 59:369-83, 1983 https://doi.org/10.3171/jns.1983.59.3.0369
  19. Mitchell P, Kerr R, Mendelow AD,Molyneux A. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? Journal of neurosurgery 108:437-42, 2008 https://doi.org/10.3171/JNS/2008/108/3/0437
  20. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267-74, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  21. Mont'alverne F, Musacchio M, Tolentino V, Riquelme C, Tournade A. Endovascular management for intracranial ruptured aneurysms in elderly patients: outcome and technical aspects. Neuroradiology 47:446-57, 2005 https://doi.org/10.1007/s00234-005-1345-0
  22. Nieuwkamp DJ, Rinkel GJ, Silva R, Greebe P, Schokking DA,Ferro JM. Subarachnoid haemorrhage in patients > or = 75 years: clinical course, treatment and outcome. J Neurol Neurosurg Psychiatry 77:933-7, 2006 https://doi.org/10.1136/jnnp.2005.084350
  23. Park JW,Choi CH. Clinical Analysis of Operation for Elderly Patients with Cerebral Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc 34:554-9, 2003
  24. Pierot L, Spelle L,Vitry F. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 39:2497-504, 2008 https://doi.org/10.1161/STROKEAHA.107.512756
  25. Proust F, Gerardin E, Derrey S, Lesveque S, Ramos S, Langlois O, et al. Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients. J Neurosurg 112:1200-7, 2010 https://doi.org/10.3171/2009.10.JNS08754
  26. Safar M. Ageing and its effects on the cardiovascular system. Drugs 39 Suppl 1:1-8, 1990
  27. Sedat J, Dib M, Lonjon M, Litrico S, Von Langsdorf D, Fontaine D, et al. Endovascular treatment of ruptured intracranial aneurysms in patients aged 65 years and older: follow-up of 52 patients after 1 year. Stroke 33:2620-5, 2002 https://doi.org/10.1161/01.STR.0000034788.70971.14
  28. Stachniak JB, Layon AJ, Day AL,Gallagher TJ. Craniotomy for intracranial aneurysm and subarachnoid hemorrhage. Is course, cost, or outcome affected by age? Stroke 27:276-81, 1996 https://doi.org/10.1161/01.STR.27.2.276
  29. Sugiu K, Tokunaga K, Watanabe K, Sasahara W, Tagawa M, Tamesa N, et al. Endovascular treatment for elderly patients with ruptured aneurysm. Acta Neurochir Suppl 94:7-9, 2005 https://doi.org/10.1007/3-211-27911-3_2
  30. Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 51:1457, 1988
  31. Torbey MT, Hauser TK, Bhardwaj A, Williams MA, Ulatowski JA, Mirski MA, et al. Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 32:2005-11, 2001 https://doi.org/10.1161/hs0901.094622
  32. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD, Jr., Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103-10, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3
  33. Yamashita K, Kashiwagi S, Kato S, Takasago T, Ito H. Cerebral aneurysms in the elderly in Yamaguchi, Japan. Analysis of the Yamaguchi Data Bank of Cerebral Aneurysm from 1985 to 1995. Stroke 28:1926-31, 1997 https://doi.org/10.1161/01.STR.28.10.1926
  34. Yano S, Hamada J, Kai Y, Todaka T, Hara T, Mizuno T, et al. Surgical indications to maintain quality of life in elderly patients with ruptured intracranial aneurysms. Neurosurgery 52:1010-5; discussion 1015-6, 2003 https://doi.org/10.1227/01.NEU.0000057693.15423.10
  35. Yoshioka H, Inagawa T, Tokuda Y,Inokuchi F. Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage. Surg Neurol 53:119-24; discussion 124-25, 2000 https://doi.org/10.1016/S0090-3019(99)00185-8