We report the unique case of a 67-year-old female patient with an incidentally discovered massively calcified aneurysm of the anterior communicating artery. After interdisciplinary discussion, we decided to attempt clipping the aneurysm because interventional therapy did not seem feasible and anchoring a stent would also have been difficult because of the morphology of the aneurysm. The clipping attempt was unsuccessful because of the aneurysm’s massive calcification with strong adherence to the sphenoid planum. The aneurysm was then successfully occluded using pCONus 2-assisted coiling. We illustrate this and consecutive procedures, and we reviewed the literature on aneurysm calcification.

Population-based data on incidence and mortality risk factors, particularly in very elderly patients with traumatic subarachnoid hemorrhage (tSAH) are limited. This study analyzed epidemiology, comorbidities, complications, age-specific incidence rates, and predictors of in-hospital mortality in patients with tSAH in Germany, with a focus on those aged ≥80 years. This retrospective cross-sectional study included all hospitalized patients with tSAH (ICD-10 S06.6) in Germany from 2019 to 2022, using nationwide administrative data from the Institute for the Hospital Remuneration System (InEK-GmbH). Demographics, comorbidities, complications, diagnostic procedures, ICU treatment, and in-hospital mortality were analyzed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using univariable analyses. Age-specific incidence rates were derived from Federal Statistical Office (Destatis) population data. In a nationwide cohort of 67,684 tSAH patients, in-hospital mortality was 9.1%. The incidence of tSAH was 34.4 per 100,000 and increased sharply with age. Hypertension (44.5%) and atrial fibrillation (14.8%) were common. Mortality was higher in patients with atrial fibrillation (OR 1.86), cardiac pacemakers (OR 1.65), and three-vessel coronary artery disease (OR 1.54). Prolonged unconsciousness (>24 h) was the strongest predictor of death (OR 16.32), followed by cerebral edema (OR 4.70). Septic shock, renal failure, and traumatic shock carried the highest mortality risk. tSAH is associated with substantial in-hospital mortality, particularly in very elderly patients and those with cardiac comorbidities. These predictors/associations may support risk stratification and early intensive care management.