Geriatric neurosurgery.

The "elderly," aged 65 and over, represent a rapidly growing proportion of the American population. Their percentage among the neurosurgical admissions at Henry Ford Hospital increased from 14.4% in 1978 to 22.4% in 1984. Occlusive cerebrovascular disease was the most frequent pathology seen, representing 40% of the population studied. Spinal degenerative myeloradiculopathy represented 14%, tumors 7%, trauma 5.4%, and intracranial hematomas represented 4% of the population. Vascular anomalies represented 3.3% of the patient group, with almost the same number of patients presenting with intracranial hemorrhage. The percentage of patients who were surgically treated was 58%. Mortality was 6.5%, with only 2.5% of the patients requiring special-care-facility placement following release from the hospital. An older group, aged 85 and over, represented 4% of our geriatric population. In the age 85+ group, occlusive cerebrovascular disease was the leading pathology (18% of the population), followed by subdural hematomas (15%), spinal degenerative myeloradiculopathy (11.6%), trigeminal neuralgias (7%), hydrocephalus (4%), vascular anomalies (4%), and tumors (4%). Patients in the age 85+ group were surgically treated in 41% of the cases, with a mortality of less than 10%. In the past, older age (greater than 65 years) was believed to be a contraindication to surgery, however, the increased life expectancy, number, and health of this population made reconsideration of this arbitrary age limit essential. We feel that age alone is not a barrier to proper neurosurgical treatment when other risk factors are adequately managed.