Outcomes of Microsurgical Clipping in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

Abstract The number of older patients diagnosed with subarachnoid hemorrhage (SAH) is increasing. However, whether these patients should be treated with microsurgical clipping remains controversial. In this study, we aimed to compare older and younger patients with SAH due to ruptured intracerebral aneurysms and evaluate the validity of microsurgical treatment in patients over 80 years old. Eight hundred twenty-one patients with SAH due to ruptured intracerebral aneurysms were treated with microsurgical clipping (n = 707), endovascular coil embolization (n = 54), and conservative treatment (n = 60). We evaluated 707 patients who underwent microsurgical clipping for ruptured intracerebral aneurysms. Patients in the seventies with World Federation of Neurosurgical Surgeons (WFNS) grades I to III and IV to V achieved 75.0% and 32.9% favorable outcomes, respectively, which were approximately equal to the outcomes in patients under 70 years of age (84.8% and 42.3%, respectively). Patients aged under and over 80 years with WFNS grades I to III achieved favorable outcomes at 82.8% and 45.5%, respectively, with a significant difference (p < 0.05). Patients aged under and over 80 with WFNS grades IV and V achieved favorable outcomes at 39.5% and 5.6%, respectively, with a significant difference (p < 0.05). However, it is possible to achieve a favorable outcome in almost half of patients even if their age is 80 years or older. Patients over 80 years old with aneurysmal SAH need careful management to improve outcomes. Our findings revealed that an age of 80 years was a valid cutoff value for achieving a favorable outcome with surgical interventions in older patients with aneurysmal SAH. Accumulating data on endovascular coil embolization and microsurgical clipping in patients aged over 80 years with aneurysmal SAH and evaluating the outcomes of these treatment modalities are necessary.