Observational study of treated non-traumatic subarachnoid hemorrhage in nonagenarians

Objective: With an aging society worldwide, we can expect an increased frequency of clinical therapeutic judgements for patients 90 years or older, nonagenarians, with subarachnoid hemorrhage. However, little evidence exists as to whether surgical treatment is safe for them and leads to increased survival rates. We thus report the possible therapeutic strategies and clinical features thorough this observational study. Patients and methods: 15 consecutive cases at two centers were collected retrospectively. Treatment methods were divided into conservative therapy or aggressive surgery including clipping or coiling surgery. Data were calculated statistically using SPSS (R) version 21 (Japan IBM, Tokyo, Japan). Results: The mean age of patients was 91.5 +/- 1.7 years. The World Federation of Neurological Surgeons (WFNS) grade on arrival was 3.5 +/- 1.4, and the average Fisher scale was 3.8 +/- 0.4. Mortality of all patients was 66.7%. Symptomatic vasospasm was observed in one case. Five patients underwent surgical treatment, including clipping or coiling surgery. Mortality was 20.0% in those who represented WFNS grade 2/3 and received surgical treatment while 90.0% in those who represented WFNS grade 3 to 5 and received conservative treatment. Therefore, our results indicate that surgical intervention is associated with increased life expectancy in good WFNS grade. Furthermore, the modified Rankin Scale score in all patients deteriorated with the disease, while relatively more deaths have occurred in the non-treated patient population. Conclusion: Considering clipping surgery or intervention in nonagenarians might be of benefit in favorable circumstances, i.e. WFNS grade 1, 2 or 3.