Microsurgical Clipping for Intracranial Aneurysms in the Elderly: Comparable Outcomes to Younger Cohorts

Introduction: In recent years, there has been a shift towards endovascular treatment of intracranial aneurysms (IAs), particularly among elderly patients. However, microsurgical clipping remains the preferred modality for aneurysms of certain morphology and location. Our study aimed to compare outcomes for clipping based on age.

Methods: This was a retrospective single-center study of patients who underwent microsurgical clipping of an IA between February 2016- November 2022. Propensity scores were estimated using the 1:2 nearest neighbour method. Outcomes of interest were intra-operative/ post-operative complications, length of stay, non-home discharge (NHD), functional dependence on discharge and mortality.

Results: After PSM, 50 patients aged above 70 were matched with 100 patients below 70 years of age. Aneurysm location, morphology and rupture status were comparable across matched cohorts. There was no significant difference in complications (14.0% in ≥70 vs. 13.0% in < 70, p = 1), extended length of stay (30% in ≥70 vs. 19% in < 70, p= .129) or non-home discharge (38.0% in ≥70 vs. 26.0% in < 70, p = 0.131), functional dependence on discharge (22% in ≥70 vs. 17% in < 70, p= .509) and mortality (8.0% in ≥70 vs. 2.0% in < 70, p = 0.169).

Conclusion : Our results suggest comparable rates of complications, LOS, NHD, functional dependence and mortality in comparison to younger patients. We would like to acknowledge the importance of patient selection and encourage further studies to assess the safety of clipping in the elderly.