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[Chronic subdural hematoma in patients over 80 years of age]
M Gelabert-González1, J M Fernández-Villa, E López-García
1Servicio de Neurocirugía, Hospital Clínico de Santiago, Departamento de Cirugía, Universidad de Santiago de Compostela.
Insights
Minimal surgery, such as burr hole craniostomy with drainage, is effective for elderly patients with chronic subdural hematoma (CSH). This approach yields good outcomes, indicating age and comorbidities are not poor prognostic factors for CSH treatment.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Neurology
Context:
- Chronic subdural hematoma (CSH) is a common intracranial hemorrhage, particularly in elderly individuals.
- Elderly patients often present with systemic diseases, complicating therapeutic decisions for CSH.
- Intracranial hemorrhage management in the elderly requires careful consideration of patient factors and treatment efficacy.
Purpose:
- To evaluate the efficacy and safety of minimal surgical intervention for chronic subdural hematoma (CSH) in patients over 80 years old.
- To assess the outcomes of burr hole craniostomy with closed drainage in a geriatric CSH population.
- To determine if advanced age or comorbidities impact the prognosis of surgically treated CSH.
Summary:
- A retrospective study analyzed 90 patients older than 80 with CSH, all treated with burr hole craniostomy and drainage.
- Clinical evaluation used the Markwalder classification; 7.7% of patients died (none from surgery), and 6.6% required reintervention for recurrent CSH.
- The study found that 76.6% of patients achieved excellent outcomes (grades 0-1), suggesting minimal surgery is a viable first-line treatment.
Impact:
- Minimal surgical drainage is a safe and effective first-line treatment for CSH in elderly patients.
- The study suggests that advanced age and concomitant diseases are not significant negative prognostic factors for CSH treatment outcomes.
- These findings support the use of simple drainage procedures for CSH in the elderly, potentially improving quality of life and reducing healthcare burdens.
Introduction:
Chronic subdural hematoma (CSH) represents one of the most frequent types of intracranial hemorrhage. Most occur in elderly patients causing a variety of therapeutic problems associated to systemic diseases.
Patients And Methods:
A retrospective study of 90 patients older than 80 years of age with chronic subdural hematoma treated in the last 15 years was undertaken. For clinical evaluation on admission and at discharge we used the classification of Markwalder. Surgical treatment was performed in all patients and a burr hole craniostomy with closed drainage system was used.
Results:
On admission, 73 patients (80%) were in satisfactory condition (grades 0-2); 17 (20%) were grade 3 or 4. Seven (7.7%) patients died but none due to surgery. In 6 (6.6%) of the patients, surgical reintervention was required to remove a recurring CSH. In 76.6% of the patients, the results achieved were graded 0 or 1.
Conclusions:
In our experience CSH in elderly patients should be treated with minimal surgery with a simple drainage of the subdural space. The good results suggest that the procedure could be considered as a first procedure in these patients and that age or concomitant diseases do not appear to be poor prognostic factors.