• Norihito Shimamura, Masato Naraoka, Takeshi Katagai, Kosuke Katayama, Kiyohide Kakuta, Naoya Matsuda, and Hiroki Ohkuma.
• Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. Electronic address: shimab@hirosaki-u.ac.jp.
• World Neurosurg. 2016 Jun 1; 90: 504-510.

BackgroundThe number of elderly subarachnoid hemorrhage (SAH) patients has been increasing. The aim of this study was to analyze long-term outcome for elderly (≥75 years) SAH patients and to establish a treatment strategy.MethodsFrom January 2005 to December 2013, 86 consecutive cases were treated. We used a modified Rankin Scale (mRS) at the outpatient clinic or a telephone interview of patients and/or families. Kaplan-Meier plots were done for mortality and independent (mRS 0 ∼ 2) state. Multivariate analysis was done to distinguish factors that influence on outcome.ResultsMedian age was 79, Hunt-Kosnik grade 1 ∼ 3 was 79%, and the radical intervention (clipping or coiling) rate was 78%. Mean follow-up period was 28.7 ± 3.4 standard error months. Half of deaths occurred during the first two months. The number of cases of independent living gradually decreased to 50% at 28 months after SAH. Half of patients lived independently for 36 months at HK grades 1 to 3, and 3 months at HK grades 4 to 5 (p < 0.05). Half of patients lived independently for 40 months in the radical intervention group, and 14 months in the conservative treatment group (p < 0.05). Multivariate analysis for independent living revealed that gender, pre-morbid condition, HK grade, and postoperative complication were significant (p < 0.05).ConclusionsGood-grade elderly SAH cases that were independent pre-stroke should have radical intervention performed for aneurysm. Avoiding perioperative complications have a positive influence on long-term independent living.Copyright © 2016 Elsevier Inc. All rights reserved.

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