Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Outcome of Patients Over 90 Years of Age Treated for Chronic Subdural Hematoma

  • Dobran, Mauro (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Marini, Alessandra (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Nasi, Davide (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Liverotti, Valentina (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Benigni, Roberta (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Costanza, Martina Della (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Mancini, Fabrizio (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche) ;
  • Scerrati, Massimo (Department of Neurosurgery, Umberto I General Hospital, Universita Politecnica delle Marche)
  • Received : 2018.01.16
  • Accepted : 2018.03.17
  • Published : 2022.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Chronic subdural hematoma (CSDH) is one of the most common pathology in daily neurosurgical practice and incidence increases with age. The aim of this study was to evaluate the prognostic factors and surgical outcome of CSDH in patients aging over 90 years compared with a control group of patients aging under 90 years. Methods : This study reviewed 25 patients with CSDH aged over 90 years of age treated in our department. This group was compared with a younger group of 25 patients aged below their eighties. At admission past medical history was recorded concerning comorbidities (hypertension, dementia, ictus cerebri, diabetes, and heart failure or attack). History of alcohol abuse, anticoagulant and antiplatelet therapy, head trauma and seizures were analyzed. Standard neurological examination and Markwalder score at admission, 48 hours after surgery and 1-6 months follow-up, radiologic data including location and CSDH maximum thickness were also evaluated. Results : Their mean age was 92.8 years and the median was 92.4 years (range, 90-100 years). In older group, the Markwalder evaluation at one month documented the complete recovery of 24 patients out of 25 without statistical difference with the younger group. This data was confirmed at 6-month follow-up. One patient died from cardiovascular failure 20 days after surgery. The presence of comorbidities, risk factors (antiplatelet therapy, anticoagulant therapy, history of alcohol abuse, and head trauma), preoperative symptoms, mono or bilateral CSDH, maximum thickness of hematoma, surgical time and recurrence were similar and statistically not significant in both groups. Conclusion : In this study, we demonstrate that surgery for very old patients above 90 years of age affected by CSDH is safe and allows complete recovery. Comparing two groups of patients above and under 90 years old we found that complication rate and recovery were similar in both groups.

Keywords

References

  1. Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK : Chronic subdural haematoma in the elderly. Postgrad Med J 78 : 71-75, 2002 https://doi.org/10.1136/pmj.78.916.71
  2. Ashiyaman V, Chatterjee I : Increasing incidence of chronic subdural haematoma in elderly. QJM 110 : 775, 2017 https://doi.org/10.1093/qjmed/hcx143
  3. Baechli H, Nordmann A, Bucher HC, Gratzl O : Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 27 : 263-266, 2004
  4. Cameron MM : Chronic subdural hematoma: a review of 114 cases. J Neurol Neurosurg Psychiatry Sept 41 : 834-839, 1978 https://doi.org/10.1136/jnnp.41.9.834
  5. Castro-Rodriguez C, Roman-Pena P, Aran-Echabe E, Gelabert-Gonzalez M : Chronic subdural haematomas in very elderly patients. Rev Esp Geriatr Gerontol 51 : 309-316, 2016 https://doi.org/10.1016/j.regg.2016.05.003
  6. de Araujo Silva DO, Matis GK, Costa LF, Kitamura MA, de Carvalho Junior EV, de Moura Silva M, et al. : Chronic subdural hematoma and the elderly: surgical result from series of 125 cases: old "horses" are not to be shot! Surg Neurol Int 3 : 150, 2012 https://doi.org/10.4103/2152-7806.104744
  7. De Bonis P, Trevisi G, de Waure C, Sferrazza A, Volpe M, Pompucci A, et al. : Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One 8 : e68732, 2013 https://doi.org/10.1371/journal.pone.0068732
  8. Dobran M, Iacoangeli M, Scortichini AR, Mancini F, Benigni R, Nasi D, et al. : Spontaneous chronic subdural hematoma in young adult: the role of missing coagulation factor. G Chir 38 : 66, 2017 https://doi.org/10.11138/gchir/2017.38.2.066
  9. Dobran M, Iacoangeli M, Di Somma LG, Di Rienzo A, Colasanti R, Nocchi N, et al. : Neurological outcome in a series of 58 patients operated for traumatic thoracolumbar spinal cord injuries. Surg Neurol Int 5(Suppl 7) : S329-S332, 2014
  10. Dobran M, Iacoangeli M, Nasi D, Nocchi N, Di Rienzo A, di Somma L, et al. : Posterior titanium screw fixation without debridement of infected tissue for the treatment of thoracolumbar spontaneous pyogenic spondylodiscitis. Asian Spine J 10 : 465-471, 2016 https://doi.org/10.4184/asj.2016.10.3.465
  11. Dobran M, Nasi D, Brunozzi D, di Somma L, Gladi M, Iacoangeli M, et al. : Treatment of unstable thoracolumbar junction burst fractures: short-segment pedicle fixation with inclusion of fracture level versus long-term instrumentation. Acta Neurochir (Wien) 158 : 1883-1889, 2016 https://doi.org/10.1007/s00701-016-2907-0
  12. Gelabert-Gonzales M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R : Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 107 : 223-229, 2005 https://doi.org/10.1016/j.clineuro.2004.09.015
  13. Jones S, Kafetz K : A prospective study of chronic subdurale haematomas in elderly patients. Age ageing 28 : 519-521, 1999 https://doi.org/10.1093/ageing/28.6.519
  14. Karibe H, Kameyama M Kawase M, Hirano T, Kawaguchi T, Tominaga T : Epidemiology of chronic subdural hematomas. No Shinkei Geka 39 : 1149-1153, 2011
  15. Kudo H, Kuwamura K, Izawa I, Sawa H, Tamaki N : Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect. Neurol Med Chir (Tokyo) 32 : 207-209, 1992 https://doi.org/10.2176/nmc.32.207
  16. Lee KS : Natural history of chronic subdural haematoma. Brain Inj 18 : 351-358, 2004 https://doi.org/10.1080/02699050310001645801
  17. Leroy HA, Aboukais R, Reyns N, Bourgeois P, Labreuche J, Duhamel A, et al. : Predictors of functional outcomes and recurrence of chronic subdural hematomas. J Clin Neurosci 22 : 1895-1900, 2015 https://doi.org/10.1016/j.jocn.2015.03.064
  18. Markwalder TM : Chronic subdural hematomas: a review. J Neurosurg 54 : 637-645, 1981 https://doi.org/10.3171/jns.1981.54.5.0637
  19. Uno M, Toi H, Hirai S : Chronic subdural hematoma in elderly patients: is this disease benign? Neurol Med Chir (Tokyo) 57 : 402-409, 2017 https://doi.org/10.2176/nmc.ra.2016-0337
  20. Mori K, Maeda M : Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41 : 371-381, 2001 https://doi.org/10.2176/nmc.41.371
  21. Rust T, Kiemer N, Erasmus A : Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci 13 : 823-827, 2006 https://doi.org/10.1016/j.jocn.2004.12.013
  22. Sambasivan M : An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol 47 : 418-422, 1997 https://doi.org/10.1016/S0090-3019(97)00188-2
  23. Spallone A, Giuffre R, Gagliardi FM, Vagnozzi R : Chronic subdurale haematoma in extremely aged patients. Eur Neurol 29 : 18-22, 1989 https://doi.org/10.1159/000116370
  24. Tabuchi S, Kadowaki M : Chronic subdurale hematoma in patients over 90 years old in a super-aged society. J Clin Med Res 6 : 379-383, 2014
  25. Toi H, Kinoshita K, Hirai S, Takai H, Hara k, Matsushita N, et al. : Present epidemiology of chronic subdural hematoma in Japan: analysis of 63,358 cases recorded in a national administrative database. J Neurosurg 128 : 222-228, 2018 https://doi.org/10.3171/2016.9.jns16623
  26. Tsai TH, Lieu AS, Hwang SL, Huang TY, Hwang YF : A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes. J Trauma 68 : 571-575, 2010 https://doi.org/10.1097/TA.0b013e3181a5f31c