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  • Age-adjusted analysis of 697 patients with chronic subdural hematoma – Clinical presentation and postoperative outcome

    Final Number:
    646

    Authors:
    Karl-Michael Schebesch MD; Petra Schoedel; Elisabeth Bruendl; Alexander T. Brawanski MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The prevalence of dementia syndromes increases. Although chronic subdural hematoma (CSH) ? one cause of dementia and cognitive decline ? is surgically treatable, little is known about age-adjusted rates of restoring functional integrity. To evaluate the clinical symptoms and the course of CSH in patients in the different decades of life, we reviewed the charts of consecutive patients with CSH.

    Methods: 697 patients with CSH (461 men, 236 women) who had been operated on in our department between 1992 and 2013 were included. The charts were analyzed for demographical data, clinical presentation and outcome, type and number of surgery, radiological findings, days in hospital, complications, and history of trauma. Subgroup analysis was done according to age (age group AG) 1) <65 years, 2) 66-75 years, 3) 76-85 years, and 4) 86-95 years.

    Results: 96.5% (n=673) of the patients were treated by burrhole trephination and subdural drainage. The mean thickness of the hematomas was 2.1 cm. Surgery-related morbidity was 4.9% (n=34), and in-hospital mortality was 1.1% (n=8). No significant difference was found between the age groups concerning the complication rates, but patients older than 75 years required reoperation more frequently (p=0.001). Preoperatively, the most common symptoms were headache in AGs 1 and 2 (56.3% and 48.5%) and cognitive decline in AGs 3 to 5 (54.9%, 51.9%, and 50.0%). The most common clinical residuals were motor deficits in AG 1 (10.4%), mnestic deficits in AG 2 (10.7%), AG 4 (24.1%), and AG 5 (50.0%), and organic brain syndrome in AG 3 (15.0%).

    Conclusions: CSH predominantly caused unspecific symptoms such as headache and cognitive decline. Surgical treatment of the hematoma immediately relieved symptoms in patients of all age groups. However, our data showed significant improvement rates depending on a patient’s age that should be taken into consideration when advising patients on surgical treatment of CSH.

    Patient Care: Better understanding of the disease and improved advising of patients and relatives

    Learning Objectives: Age-dependent functional imrovement in chronic subdural hematomas

    References:

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