FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Surgical neurology international2012; 3; 150; doi: 10.4103/2152-7806.104744

Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old “horses” are not to be shot!

Abstract: To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country. Methods: One hundred and twenty-five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restauração, Recife-PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS ≤ 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome. Results: The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS ≥9 on admission presented better outcome (P < 0.05). Recurrent cases presented a poor outcome (P < 0.05). Conclusions: This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.
Get Full Text
Publication Date: 2012-12-14 PubMed ID: 23372967PubMed Central: PMC3551521DOI: 10.4103/2152-7806.104744Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research paper discusses a retrospective study examining the outcomes of elderly patients with chronic subdural hematomas who underwent surgery in a hospital in Brazil. Key determinants of patient outcomes overall were the Glasgow Coma Scale score on admission and whether or not the condition recurred.

Objective and Methodology

  • The research aimed to present an accumulated experience from treating chronic subdural hematomas (CSDH), a common neurological disorder, especially in patients of advanced age. The study was conducted in a Neurosurgical Department of a hospital in Brazil.
  • The analysis involved a retrospective study of 125 consecutive patients who underwent surgery for CSDH between January 2006 and May 2008.
  • The researchers used the Glasgow Outcome Scale (GOS) to determine the patients’ outcomes after 6 months. This scale measures patients’ level of functioning following a brain injury, with higher scores indicating better outcomes.
  • Factors considered included the patients’ age, admission Glasgow Coma Scale (GCS) score, location of hematomas (left, right, or bilateral), the use of a drainage system, and whether the condition recurred.

Results

  • The median age of the patients was 69, with a significant majority of the patients being male (102/23). More than half the patients (60.8%) had a history of trauma.
  • The median GCS on admission was 14, indicating a relatively high level of consciousness and neurological functioning.
  • The location of hematomas varied, with a slight majority (64) being on the left, 42 on the right, and 19 cases (15.2%) being bilateral.
  • Drainage systems were used in the majority of cases (93.6%). Recurrence occurred in 8.8% of the patients.
  • 103 patients had a good outcome at 6 months. The mortality rate was relatively low, at 11.2%.
  • There was an statistically significant association between the admission GCS score and the outcome, with patients having an initial GCS score of 9 or more having a better outcome.
  • The recurrence of the condition was also statistically associated with a poorer outcome.

Conclusion

  • The study concludes that admission GCS scores and recurrence status are the primary factors associated with outcomes in patients with CSDH.
  • Contrary to conventional beliefs, advanced age was not found to be a contraindication for surgical treatment, challenging the traditional idea that elderly patients may not benefit from surgical intervention.
  • The researchers highlighted that their study, exclusively conducted on a Brazilian population, was the first of its kind in the English literature. This could pave the way for further discussion in the field, including potentially more complex, multivariate debates.

Cite This Article

APA
de Araújo Silva DO, Matis GK, Costa LF, Kitamura MA, de Carvalho Junior EV, de Moura Silva M, Barbosa BJ, Pereira CU, da Silva JC, Birbilis TA, de Azevedo Filho HR. (2012). Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old “horses” are not to be shot! Surg Neurol Int, 3, 150. https://doi.org/10.4103/2152-7806.104744

Publication

Surgical neurology international
ISSN: 2152-7806
NlmUniqueID: 101535836
Country: United States
Language: English
Volume: 3
Pages: 150
PII: 150

Researcher Affiliations

de Araújo Silva, Danilo Otávio
  • Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil.
Matis, Georgios K
    Costa, Leonardo Ferraz
      Kitamura, Matheus Augusto Pinto
        de Carvalho Junior, Eduardo Vieira
          de Moura Silva, Monalisa
            Barbosa, Breno José A P
              Pereira, Carlos Umberto
                da Silva, Joacil Carlos
                  Birbilis, Theodossios A
                    de Azevedo Filho, Hildo Rocha Cirne

                      References

                      This article includes 36 references
                      1. Abouzari M, Rashidi A, Rezaii J, Esfandiari K, Asadollahi M, Aleali H, Abdollahzadeh M. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery.. Neurosurgery 2007 Oct;61(4):794-7; discussion 797.
                        pubmed: 17986941doi: 10.1227/01.neu.0000298908.94129.67google scholar: lookup
                      2. Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, Shirani A, Asadollahi M, Aleali H. Outcomes and recurrence rates in chronic subdural haematoma.. Br J Neurosurg 2007 Jun;21(3):272-5.
                        pubmed: 17612917doi: 10.1080/02688690701272232google scholar: lookup
                      3. Amirjamshidi A, Abouzari M, Rashidi A. Glasgow Coma Scale on admission is correlated with postoperative Glasgow Outcome Scale in chronic subdural hematoma.. J Clin Neurosci 2007 Dec;14(12):1240-1.
                        pubmed: 17382549doi: 10.1016/j.jocn.2006.03.030google scholar: lookup
                      4. Antunes DG, Alliez RJ, Eva L, Reynier Y, Alliez B. Analysis of the surgical treatment of chronic subdural hematoma in 100 elderly patients.. Arq Bras Neurocir 2006;25:156–60.
                      5. Arbit E, Patterson RH Jr, Fraser RA. An implantable subdural drain for treatment of chronic subdural hematoma.. Surg Neurol 1981 Mar;15(3):175-7.
                        pubmed: 7221864doi: 10.1016/0090-3019(81)90133-6google scholar: lookup
                      6. Arseni C, Stanciu M. Particular clinical aspects of chronic subdural haematoma in adults.. Eur Neurol 1969;2(2):109-22.
                        pubmed: 5802541doi: 10.1159/000113778google scholar: lookup
                      7. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage.. J Neurosurg 1986 Aug;65(2):183-7.
                        pubmed: 3723175doi: 10.3171/jns.1986.65.2.0183google scholar: lookup
                      8. ECHLIN FA, SORDILLO SV, GARVEY TQ Jr. Acute, subacute, and chronic subdural hematoma.. J Am Med Assoc 1956 Aug 4;161(14):1345-50.
                        pubmed: 13331793doi: 10.1001/jama.1956.02970140001001google scholar: lookup
                      9. El-Kadi H, Miele VJ, Kaufman HH. Prognosis of chronic subdural hematomas.. Neurosurg Clin N Am 2000 Jul;11(3):553-67.
                        pubmed: 10918029
                      10. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients.. Surg Neurol 1997 Sep;48(3):220-5.
                        pubmed: 9290707doi: 10.1016/s0090-3019(97)80031-6google scholar: lookup
                      11. Fogelholm R, Heiskanen O, Waltimo O. Chronic subdural hematoma in adults. Influence of patient's age on symptoms, signs, and thickness of hematoma.. J Neurosurg 1975 Jan;42(1):43-6.
                        pubmed: 1167376doi: 10.3171/jns.1975.42.1.0043google scholar: lookup
                      12. Foelholm R, Waltimo O. Epidemiology of chronic subdural haematoma.. Acta Neurochir (Wien) 1975;32(3-4):247-50.
                        pubmed: 1225014doi: 10.1007/bf01405457google scholar: lookup
                      13. Gastone P, Fabrizia C, Homere M, Cacciola F, Alberto M, Nicola DL. Chronic subdural hematoma: results of a homogeneous series of 159 patients operated on by residents.. Neurol India 2004 Dec;52(4):475-7.
                        pubmed: 15626837
                      14. Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases.. Clin Neurol Neurosurg 2005 Apr;107(3):223-9.
                        pubmed: 15823679doi: 10.1016/j.clineuro.2004.09.015google scholar: lookup
                      15. Hamilton MG, Frizzell JB, Tranmer BI. Chronic subdural hematoma: the role for craniotomy reevaluated.. Neurosurgery 1993 Jul;33(1):67-72.
                        pubmed: 8355849doi: 10.1227/00006123-199307000-00010google scholar: lookup
                      16. Javadi A, Amirjamshidi A, Aran S, Hosseini SH. A randomized controlled trial comparing the outcome of burr-hole irrigation with and without drainage in the treatment of chronic subdural hematoma: a preliminary report.. World Neurosurg 2011 May-Jun;75(5-6):731-6; discussion 620-3.
                        pubmed: 21704944doi: 10.1016/j.wneu.2010.11.042google scholar: lookup
                      17. Kotwica Z, Brzeziński J. Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients.. Br J Neurosurg 1991;5(5):461-5.
                        pubmed: 1764227doi: 10.3109/02688699108998474google scholar: lookup
                      18. Kwon TH, Park YK, Lim DJ, Cho TH, Chung YG, Chung HS, Suh JK. Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume.. J Neurosurg 2000 Nov;93(5):796-9.
                        pubmed: 11059660doi: 10.3171/jns.2000.93.5.0796google scholar: lookup
                      19. Markwalder TM, Seiler RW. Chronic subdural hematomas: to drain or not to drain?. Neurosurgery 1985 Feb;16(2):185-8.
                        pubmed: 3974829doi: 10.1227/00006123-198502000-00010google scholar: lookup
                      20. Matsumoto K, Akagi K, Abekura M, Ryujin H, Ohkawa M, Iwasa N, Akiyama C. Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage.. Neurol Res 1999 Apr;21(3):277-80.
                        pubmed: 10319336doi: 10.1080/01616412.1999.11740931google scholar: lookup
                      21. Mckissock W, Richardson A, Bloom WH. Subdural hematoma.A review of 389 cases.. Lancet 1960;1:1365–9.
                      22. 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) 2001 Aug;41(8):371-81.
                        pubmed: 11561347doi: 10.2176/nmc.41.371google scholar: lookup
                      23. Nakaguchi H, Tanishima T, Yoshimasu N. Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage.. J Neurosurg 2000 Nov;93(5):791-5.
                        pubmed: 11059659doi: 10.3171/jns.2000.93.5.0791google scholar: lookup
                      24. Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence.. J Neurosurg 2001 Aug;95(2):256-62.
                        pubmed: 11780895doi: 10.3171/jns.2001.95.2.0256google scholar: lookup
                      25. Probst C. Peritoneal drainage of chronic subdural hematomas in older patients.. J Neurosurg 1988 Jun;68(6):908-11.
                        pubmed: 3373286doi: 10.3171/jns.1988.68.6.0908google scholar: lookup
                      26. Ramachandran R, Hegde T. Chronic subdural hematomas--causes of morbidity and mortality.. Surg Neurol 2007 Apr;67(4):367-72; discussion 372-3.
                        pubmed: 17350403doi: 10.1016/j.surneu.2006.07.022google scholar: lookup
                      27. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients.. J Neurosurg 1984 Aug;61(2):263-8.
                        pubmed: 6737050doi: 10.3171/jns.1984.61.2.0263google scholar: lookup
                      28. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases.. Surg Neurol 1997 May;47(5):418-22.
                        pubmed: 9131021doi: 10.1016/s0090-3019(97)00188-2google scholar: lookup
                      29. Tabaddor K, Shulmon K. Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage.. J Neurosurg 1977 Feb;46(2):220-6.
                        pubmed: 833639doi: 10.3171/jns.1977.46.2.0220google scholar: lookup
                      30. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases.. Neurosurgery 2008 Dec;63(6):1125-9; discussion 1129.
                        pubmed: 19008766doi: 10.1227/01.neu.0000335782.60059.17google scholar: lookup
                      31. 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 2010 Mar;68(3):571-5.
                        pubmed: 20065879doi: 10.1097/ta.0b013e3181a5f31cgoogle scholar: lookup
                      32. Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M. Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study.. Neurosurgery 1990 May;26(5):771-3.
                        pubmed: 2352594doi: 10.1097/00006123-199005000-00006google scholar: lookup
                      33. Wecht DA. A brief history of chronic subdural hematomas.. Neurosurg Clin N Am 2000 Jul;11(3):395-8.
                        pubmed: 10918007
                      34. Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model.. J Neurosurg 2003 Jun;98(6):1217-21.
                        pubmed: 12816267doi: 10.3171/jns.2003.98.6.1217google scholar: lookup
                      35. Yasuda CL, Morita ME, Nishimori FY, Yasuda AM, Alves HL. [Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities].. Arq Neuropsiquiatr 2003 Dec;61(4):1011-4.
                        pubmed: 14762608doi: 10.1590/s0004-282x2003000600023google scholar: lookup
                      36. Zumofen D, Regli L, Levivier M, Krayenbühl N. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system.. Neurosurgery 2009 Jun;64(6):1116-21; discussion 1121-2.
                        pubmed: 19487891doi: 10.1227/01.neu.0000345633.45961.bbgoogle scholar: lookup

                      Citations

                      This article has been cited 14 times.
                      Subscribe to our newsletter
                      Join 99,850 horse owners like you who receive our email updates on horse health and nutrition.