Elective Management of Unruptured Intracranial Aneurysms in Elderly Patients in a High-Volume Center

The number of elderly patients with unruptured intracranial aneurysms is increasing with time in aging populations; however, the choice of the proper treatment method remains inconclusive. The goal of the study is to evaluate the possible complications and treatment outcome among elderly patients with unruptured intracranial aneurysm. We analyzed 139 patients >65 years old, hospitalized between 2007 and 2017 in the high-volume neurosurgical center and diagnosed with unruptured intracranial aneurysm. From their medical records, we obtained medical history and aneurysm characteristics. Patients functional status was measured by modified Rankin Scale score on admission and at discharge. Seventy-two patients (55.97%) underwent aneurysm clipping and 39 (27.04%) coiling. Eighteen patients (11.90%) required stent assisted coiling and 4 (5.00%) had a single stent placement. A total of 133 patients (95.71%) had good treatment outcomes (modified Rankin Scale score 0–3, surgical 0.32 ± 1.03 vs. endovascular group 0.40 ± 1.12, P = 0.65). Complete or near-complete occlusion in the endovascular group was achieved in 83% directly after treatment and in 89% at 6–12 months after procedure. The microsurgical group presented 100% occlusion at follow-up. Despite the high prevalence of comorbidities in the age group >65 years old, the vast majority of patients in our series treated invasively for unruptured intracranial aneurysms presented with good treatment outcomes. Based on our results, among elderly patients, modern microsurgical as well as endovascular management of brain aneurysms in a high-volume center seems to be a safe and effective method of treatment.