Neurosurgery for the Elderly

Rha, Hyung Kyun; Lee, Kyung Jin; Cho, Kyung Keun; Park, Sung Chan; Park, Hae Kwan; Choi, Chang Rak

Abstract

People 65 years and older represent a rapidly growing proportion of the Korean population. During the last five years, the rate of population increasing in this age group has been 19.5%, in contrast to 4.6% among the general population. Before 1987, neurosurgery among the elderly was infrequent, but at our hospital, the percentage increased from 6.9% in 1991 to 13.5% in 1996. We analysed 119 geriatric neurosurgical cases(9.6% of all neurosur-gical cases) of our hospital over a recent three-year period. Cerebrovascular disease occurred most frequently(43 cases), while there were 22 cases of tumor, 15 of chronic subdural hematoma, 11 of head injury, seven of benign spinal lesion and six of hyperactive dysfunction syndrome. Among 119 cases, concomitant systemic disease was seen in 78%, with cardiovascular and pulmonary dysfunction usually present. In cases of benign spine lesion, chronic subdural hematoma, simple brain tumor and good grade aneurysm, the surgical outcome was good, but in patients with poor grade aneurysm, a large and complicated tumor or a large intracranial hematoma, the surgical outcome was relatively poor compared with that of the general population group. In the group in whom surgical outcome was good, concomitant systemic disease did not influence a patient's prognosis. The results of this study are as follows : 1) Old age in itself is not a contraindication for surgery. 2) Among geriatric neurosurgical patients, surgical decisions should be based on the pathology itself, type of surgery, envisioned, urgency of the surgical procedure and the presence of any coexisting disease that could influence the surgical outcome. 3) Agressive forms of surgical treatment of patients suffering from benign spinal lesion, chronic subdural hematoma, good grade aneurysm or simple brain tumor can be performed in the elderly ; they are safe and the results are effective. 4) Patients with poor grade aneurysm, a large intracranial hematoma with poor neurological status, or a brain tumor with systemic metastasis or severe intercurrent disease are not to be considered for surgery. 5) To reduce surgical mortality and morbidity in aging patients, careful patient selection and vigorous preoperative and postoperative care with regard to any coexisting disease are important.