A 82 year old woman developed a subarachnoid hemorrhage. She had presented with severe headache. It was the rupture of an anterior communicating artery aneurysm. She had mild dementia and had been independent until the hemorrhage. I always think twice about whether very elderly patients need repair of a cerebral aneurysm, as they may become dependent after the surgery.
My colleague said, “the repair is indicated, since she is in her early eighties.” I found that very interesting, as I had never thought about the difference between being one’s early and late eighties. I told her family, “ she needs to undergo the repair to prevent a re-rupture. However, because she is very elderly, there is a risk she may become dependent after the surgery. The decision is controversial.” They said that they wanted her to go ahead with the surgery.
I performed endovascular coiling for her. Her arteries were tortuous from the groin to the brain, making the approach to the aneurysm challenging. The aneurysm was short and wide-necked. Although the coil packing density was slightly loose, the procedure was performed safely and was considered sufficient to prevent a re-rupture in the acute phase.
WILLPOWER MELTDOWN SOMETIMES 