INTRACRANIAL ANEURYSM SURGERY IN THE 8TH AND 9TH DECADES OF LIFE - IMPACT ON POPULATION-BASED MANAGEMENT OUTCOME

THIRTEEN PERCENT OF Sweden's population (8.6 million) is aged 70 years or older, and this percentage is expected to increase over the coming decades. We have traced every diagnosed case of subarachnoid hemorrha ge in patients older than 70 years in a well-defined catchment populat ion of 953,000 individuals. The age-specific incidence for this group was 16 per 100,000 individuals per year, corresponding to 2.3 per 100, 000 inhabitants per year. In most recent population-based surgical ser ies on ruptured aneurysms, few patients in this age group are included , corresponding to only 20 to 25% of the actual number of patients, as shown in this study. Surgery is, in many cases, refused to the ''elde rly'' because of age. However, patients who are neurologically intact after the bleed and who are without severe intercurrent diseases are p otential candidates for surgical treatment. In our series, surgery yie lded good results in two-thirds of 76 patients aged 70 to 74 years who returned to independent living in good mental condition. Among matche d patients being refused surgery because of age, 75% suffered morbidit y and mortality, with move than half of the patients having died withi n the ist 3 months. When calculated for the entire population of Swede n, our data show that a 14% increase in the number of individuals achi eving complete remedy from aneurysm rupture each year can be expected with more active therapy among the elderly. Most of these patients are between 70 and 74 years old. In the 9th decade of life, aneurysm surg ery probably best remains an exception.