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Home / Equine Research Bank / Surg Neurol Int / Chronic subdural hematomas and the elderly: Surgical results...
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.
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Publication Date: 2012-12-14 PubMed ID: 23372967PubMed Central: PMC3551521DOI: 10.4103/2152-7806.104744Google Scholar: Lookup
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Summary

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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

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