Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
Philipp Taussky, Eveline Teresa Hidalgo, Hans Landolt, Javier Fandino
IntroductionWith an aging population, a growing number of elderly people are prone to falling and suffering an acute traumatic subdural hematoma (aSDH). Yet, the operative treatment of patients older than 65 years of age for aSDH remains controversial, and very limited data exist in regard to expected outcome in this elderly patient group.MethodsWe retrospectively analyzed 37 consecutive patients (all older than 65 years) who underwent craniotomy for aSDH in our department between 1 January 2002 and 31 December 2007.ResultsThirty-seven consecutive patients (54% female, 46% male) were treated for aSDH by means of craniotomy and duraplasty. Median age was 73 years (interquartile range: 10 years). Thirty patients (81%) had significant comorbidities and 43% of patients were treated by anticoagulation or thrombocyte aggregation inhibitors. Median initial Glasgow Coma Scale score was 8 (IQR: 7), and 51% had pupillary abnormalities. Perioperative morbidity occurred in 12/37 patients (32%), and 13 patients died in the postoperative period (35%). Overall outcome according to Glasgow Outcome Scale (GOS) was favorable (GOS 4 and 5) in 15/37 patients (41%); severely disabled (GOS 3) in 8/37 (22%), and unfavorable (GOS 1 and 2) in 14/37 (38%).ConclusionCraniotomy for patients older than 65 years of age remains controversial, and our case series seems to support the notion that surgical treatment is associated with significant postoperative morbidity, mortality, and adverse outcome. However, selected patients benefit from an intervention, with a good outcome in 41% of patients.
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