Endovascular treatment of intracranial aneurysms in patients 65 years or older: clinical outcomes.

BACKGROUND AND PURPOSE: A controversial discussion concerning treatment of aneurysms in elderly patients exists. The aim of this study was to analyze clinical outcome in patients older than 65 years harboring intracranial aneurysms after endovascular treatment. MATERIALS AND METHODS: A total of 108 patients aged 65 years or older (mean age, 72 years, range, 65-87 years) were selected for endovascular treatment between 1997 and 2005. A total of 85 (78.7%) patients had an acute subarachnoid hemorrhage (SAH). SAH was classified according to Hunt and Hess (HH) grade: I (n = 16), II (n = 11), III (n = 33), IV (n = 19), and V (n = 6). There were 69 aneurysms that were small; 46, medium; 8, large; and 5, giant. Occlusion rate was categorized as complete (100%), subtotal (95% to 99%), and incomplete (<95%) obliteration according to the Raymond scale. RESULTS: Endovascular treatment was technically feasible in 108 of 113 aneurysms. Complete occlusion could be achieved in 80 patients; basal remnant was seen in 26 patients and a dog ear in 2 patients. Procedural complications included thrombotic vessel occlusion (n = 9), aneurysmal rupture (n = 4), and stenosis of the parent vessel (n = 2). The Glasgow Outcome Scale (GOS) for the patients with SAH after 6 months was good recovery (n = 43), moderate disability (n = 12), severe disability (n = 28), persistent vegetative state (n = 5), and death (n = 18). Outcome for the patients with unruptured aneurysms was good recovery in all 23 patients. On follow-up digital subtraction angiography (DSA) in 69 patients, complete aneurysmal occlusion was confirmed in 81% after 6 months. Five patients with recanalization were re-treated with coiling. CONCLUSION: Endovascular treatment of ruptured and unruptured intracranial aneurysms in this subgroup was safe and effective.

[Epidural haematoma after operative evacuation of an acute subdural haematoma. Discussion of primary treatment illustrated by an unusual case]. / Epiduralhämatom nach Entlastung eines akuten Subduralhämatoms. Diskussion der Primärversorgung anhand eines ungewöhnlichen Falles.

Subdural haematomas as a consequence of severe head injury often constitute the indication for operative evacuation. Despite intensive care management postoperative computed tomography scans are essential. This is illustrated by an unusual case report of a patient suffering from an epidural haematoma after operation of an subdural haematoma. In addition, the importance of the skull X-ray in the emergency setting and intracranial pressure monitoring are discussed.

Perforation of the posterior tracheal wall during percutaneous dilatational tracheotomy.

Dilatative percutaneous tracheotomy is more and more indicated in intensive-care medicine. We report on the perforation of the posterior tracheal wall observed in 3 patients after this procedure. In 2 patients the tracheo-oesophageal fistula was closed by the use of a pediculated flap from the infrahyoideal muscle. The third patient died due to the underlying disease. As demonstrated by the 3 cases reported here, this complication cannot be avoided in every case neither by the use of an endoscope nor by extensive personal experience of the physician. The possibility of this complication should be known, because it seems to be typical of this procedure. In the case of perforation of the posterior tracheal wall, active surgical treatment seems to be a successful method to deal with this complication.