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Traumatic chronic subdural hematoma over 80 years. A preliminary prospective study
A Zingale1, V Albanese, A Romano
1Institute of Neurosurgery, University of Catania, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Hospital, Italy.
Journal of Neurosurgical Sciences
|June 1, 1997
Summary
Elderly patients with chronic subdural hematoma showed slow clinical improvement after surgery, even with residual fluid. Reoperation is not recommended if clinical improvement occurs, prioritizing conservative management.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Radiology
Background:
- Traumatic chronic subdural hematoma (CSDH) poses significant challenges in very elderly patients.
- CSDH management in the elderly requires careful consideration of surgical risks and potential complications.
- Brain re-expansion after CSDH evacuation can be impaired due to factors like reduced hemodynamic reserve.
Purpose of the Study:
- To evaluate the surgical outcomes of craniectomy and subdural drainage for CSDH in very elderly patients.
- To assess the management of persistent fluid collections and brain re-expansion post-operatively.
- To determine the optimal approach for managing residual CSDH in clinically improving elderly patients.
Main Methods:
- Six very elderly patients (mean age 85) with CSDH underwent craniectomy and 48-hour closed subdural drainage.
- Clinical status (GCS, clinical grade) and neuroimaging (CT scans) were monitored pre- and post-operatively.
- Follow-up included clinical assessment and CT evaluation within two months of discharge.
Main Results:
- No mortality directly related to the surgical procedure.
- One patient died postoperatively due to unrelated midbrain infarction.
- Progressive clinical improvement was observed in most patients despite persistent fluid collections and mass effect.
- Mean Glasgow Outcome Scale (GOS) improved to 4.6 within two months post-discharge.
- Resolution of subdural fluid collections was noted on follow-up CT scans.
Conclusions:
- Craniotomy and subdural drainage are feasible for CSDH in very elderly patients with acceptable outcomes.
- Persistent subdural fluid collection with mass effect does not necessitate reoperation if clinical improvement is evident.
- Conservative management with clinical monitoring is recommended for residual CSDH in improving elderly patients, with reoperation reserved for clinical deterioration.