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Published on: August 11, 2015
Surgical treatment for chronic subdural hematoma in the elderly: A retrospective analysis
David R Peters1,2, John Parish1,2, Steve Monk1,2
1Department of Neurosurgery, Atrium Health, 1000 Blythe Blvd, Charlotte, NC, USA, 28203.
Insights
Surgical treatments for chronic subdural hematoma in elderly patients show similar outcomes, but twist drill craniostomy has higher early recurrence. Older patients (>80) face increased stroke risk and longer hospital stays with standard craniotomy.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Neurology
Background:
- Chronic subdural hematoma (CSDH) predominantly affects the elderly.
- Elderly patients (>80) often receive less invasive procedures due to surgical risk concerns, despite limited evidence of benefit.
- Surgical outcomes for CSDH in the elderly require further investigation.
Purpose of the Study:
- To compare the efficacy and safety of different surgical interventions for CSDH in elderly patients.
- To analyze practice patterns and outcomes across age groups (65-80 vs. >80 years).
Main Methods:
- Retrospective analysis of patients aged 65+ undergoing surgical treatment for CSDH.
- Surgical options included twist drill craniostomy (TDC), burr hole craniotomy (BHC), and standard craniotomy (SC).
- Comparison of outcomes, demographics, and clinical data between patients aged 65-80 and those >80 years.
Main Results:
- No significant differences in post-operative complications, overall outcomes, or late recurrence (30-90 days) were observed among TDC, BHC, and SC.
- TDC demonstrated a significantly higher rate of recurrence within 30 days compared to BHC and SC.
- Patients over 80 treated with SC experienced a higher risk of stroke and longer hospital stays.
Conclusions:
- Twist drill craniostomy, burr hole craniotomy, and standard craniotomy yield comparable neurological outcomes in elderly CSDH patients.
- Thick membranes in CSDH are a relative contraindication for TDC due to elevated 30-day recurrence rates.
- Standard craniotomy in patients >80 is associated with increased stroke risk and prolonged hospitalization.
Background:
Chronic subdural hematoma (CSDH) is primarily a disease of the elderly. Less invasive interventions are often offered for elderly (> 80 years) patients due to concerns for elevated surgical risk, although data suggesting a clear outcome benefit is lacking.
Methods:
All patients aged 65 years or older who underwent surgical treatment for CSDH at a single institution over a 4-year period were evaluated in this retrospective analysis. Surgical options included twist drill craniostomy (TDC), burr hole craniotomy (BHC), or standard craniotomy (SC). Outcomes, demographics, and clinical data were collected. Practice patterns and outcomes for patients older than 80 years old were compared to the age 65-80 cohort.
Results:
110 patients received TDC, 35 received BHC, and 54 received SC. There was no significant difference in post-operative complications, outcomes, or late recurrence (30-90 days). Recurrence at 30 days was significantly higher for TDC (37.3% vs. 2.9% vs 16.7%, p 80 group, SC had higher risk of stroke and increased length of stay.
Conclusion:
Twist drill craniostomy, burr hole craniostomy, and standard craniotomy have similar neurologic outcomes in elderly patients. Presence of thick membranes is a relative contra-indication for TDC due to high 30-day recurrence. Patients > 80 have higher risk of stroke and increased length of stay with SC.
