BACKGROUND AND OBJECTIVES: Controversy exists regarding whether to treat unruptured intracranial aneurysms (UIAs) in older patients. This study analyzes modern outcomes among older patients who underwent microsurgical treatment for UIA. METHODS: Patients treated at a large quaternary center for UIA from January 1, 2014, to December 31, 2020, were retrospectively reviewed. Only patients with a modified Rankin Scale (mRS) score of ≤2 at admission were included. The primary outcome analyzed was mRS score at the 1-year neurological examination; poor neurological outcome was defined as an mRS score of >2. Older patients were defined as > 65 years of age. RESULTS: A total of 390 patients were treated during the 7-year study, of whom 132 (34%) were > 65 years old, with a mean (SD) age of 71 (4) years. There was no significant difference between the cohorts regarding neurological outcomes (mRS score >2) at 1-year follow-up (older vs younger, 14/132 11% vs 24/258 9.3%, P = .82). In older patients, the univariate analysis showed that significant risk factors for poor neurological outcomes were diabetes, high Charlson Comorbidity Index, aneurysm calcification, multiple aneurysms treated, de novo formation or growth of an aneurysm, and higher aspect ratios. On multivariable logistic regression analysis, only diabetes (odds ratio 19.1, 95% CI 1.98-389, P = .02) and de novo formation or growth of an aneurysm (odds ratio 12.7, 95% CI 1.65-169, P = .02) were found to be predictors of a poor neurological outcome. CONCLUSION: Microsurgical treatment of older patients with UIAs is associated with favorable 1-year neurological outcomes comparable with those in younger patients. Diabetes and de novo formation or growth of an aneurysm were associated with poor neurological outcomes in the older cohort.
Catapano et al. (Mon,) studied this question.