Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years.

BACKGROUND: Chronic subdural haematoma (cSDH) is a common disease in neurosurgical practise, especially in elderly patients. This is of growing importance as the number of elderly people in the population is increasing steadily. There are scarce data focussing especially on elderly patients with cSDH. This study intended to evaluate the outcome and peri-operative risks in elderly patients with cSDH.

METHODS: We retrospectively reviewed medical records of 322 consecutive patients aged ≥65 years treated at our department between 2002 and 2009 focussing on outcome, aetiology, peri-operative risks, recurrence rate, and co-factors such as concomitant diseases and therapy with anticoagulants. The surgical procedure included burr-hole craniostomy followed by insertion of a subdural drain in each case. The outcome was classified according to the Karnofsky performance status (KPS) and modified Rankin Scale (mRS) score. Patients were divided into three groups according to age (group I: age 65-74 years, group II: 75-84 years, group III: 85-94 years).

RESULTS: Three hundred twenty-two patients underwent burr-hole craniostomy for cSDH in 399 surgical procedures. The mean age was 76 ± 7.9 years. After surgery, the mean neurological status improved in all three groups. Overall favourable outcome (mRS 0-2) was achieved in 83 % in group I, 68 % in group II and 51 % in group III, respectively. The rate of recurrence was lower in group III (7.5 %) compared to groups I (21.5 %) and II (27.37 %, p = 0.004). Overall, complication rates and peri-operative mortality (2.75 %) did not differ significantly between the age groups.

CONCLUSION: The data of the current study suggest that treatment of cSDH is safe in elderly patients. Patients aged above 85 years carry a greater risk for peri-operative complications, i.e. aSDH, and therefore have to be examined and monitored meticulously in order to prevent complications.