Treatment and Outcome of Aneurysmal Subarachnoid Hemorrhage in the 8th and 9th Decade of life

We report our treatment outcome of patients in the 8th and 9th decade of life who presented with aneurysmal subarachnoid hemorrhage (SAH). We had 31 SAH patients who were older than 80 years. The average age was 87.9-years, and women predominated over men. World Federation of Neurological Surgeons (WFNS) grade was I in one patient, II in four, III in two, IV in four, and V in 20. Nine of the Grade V patients presented out-of-hospital cardiac arrest. Twelve patients were treated for the ruptured aneurysm either with surgical clipping or endovascular coiling. At discharge, three of them were in a good clinical state (modified Rankin Scale 1 or 2). For nine with cardiac arrest and 10 others, the aneurysm was not treated. All patients with cardiac arrest died. Among the others, eight died and two were in poor clinical state (modified Rankin Scale 4 and 5). In conclusion, most of the SAH patients over 80 years were in poor clinical grade at presentation, and not good candidates for aneurysm treatment. Most of the untreated patients died. On the other hand, one-fourth of the treated ones had good outcome. When we decide the treatment strategies for very old patients, we should be cautious and should also respect the family opinions. But for those who were independent before presentation, aneurysm treatment is a key for survival and good outcome. When the patient is clinically stable, surgical or endovascular treatment and strict postoperative care is an option even for these very old patients.