[Indication of early surgery in elderly patients with ruptured intracranial aneurysms--the comparison between surgical and conservative therapy].

The purpose of this study was to investigate the indication of direct early surgery for elderly cases aged over 70 years with ruptured intracranial aneurysms. The result of early surgical treatment in 39 elderly cases was analyzed and was compared with that of conservative treatment in 39 elderly patients. According to the multiple logistic analysis, surgery was only significant factor influenced the outcome, however, Hunt & Kosnik grade (HKG), activity of daily life (ADL) before subarachnoid hemorrhage (SAH) and past history were related to the outcome. The outcome in the direct early surgical group statistically correlated (p < 0.05) with preoperative HKG, although the outcome in the conservative group did not correlate with HKG. The outcome in conservative group was miserable because of rerupture or poor preoperative neurological grade. The indication of direct early surgery for elderly cases with ruptured intracranial aneurysms should be considered as follows, HKG 1 to 3, ADL before SAH 1, no or minor past history and age under 84 since most elderly patient was 84 in our series. Direct early surgery in elderly patients seems to improve the outcome under these indications.