Korean J Neurotrauma.  2013 Oct;9(2):92-95. 10.13004/kjnt.2013.9.2.92.

A Comparative Analysis of Chronic Subdural Hematoma in Two Age Groups of Younger and Older than 75 Years

• Ryu JW
• Lee SH
• Choi SK
• Oh IH
• Kim MK
• Park BJ
• Kim TS
• Rhee BA
• Lim YJ

• KMID: 2156107
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.92

Abstract

OBJECTIVE
Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhage. As the number of elderly people is increasing, the incidence of cSDH is growing. Therefore, we analyzed clinical manifestation of the cSDH.
METHODS
The authors retrospectively reviewed the data of the 169 patients of cSDH who were 65 years or older and undergone burr-hole trephination and closed drainage in our hospital between January 2008 and December 2012. Patients were divided into two subgroups; group A: young than 75 years, group B: 75 years or older. We analyzed the differences of clinical aspects and surgical results in both groups.
RESULTS
Proportion of male patients in group A (83.8%) was higher than in group B (58.4%) with statistical significance (p=0.003). Alteration of consciousness as an initial symptom was significantly more frequent in group A (17.5%) than in group B (4.4%)(p=0.006). Postoperatively, 164 of 169 patients (97%) were free from symptom within three days in both groups. Pneumonia followed the surgery in three patients (one in group A and two in group B).
CONCLUSION
There were no difference in the rate of complications between group A and B. Therefore, burr-hole trephination and external drainage is safe and effective management in both groups.

Keyword

Chronic subdural hematoma; Elderly; Burr hole trephination; Complication

MeSH Terms

Aged
Consciousness
Drainage
Hematoma, Subdural, Chronic*
Humans
Incidence
Intracranial Hemorrhages
Male
Pneumonia
Retrospective Studies

Reference

References

1. Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E. Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65–94 years. Acta Neurochir (Wien). 154:1549–1554. 2012.

2. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg. 65:183–187. 1986.

3. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol. 48:220–225. 1997.

4. Fogelholm R, Heiskanen O, Waltimo O. [Chronic subdural hematoma in adults]. Duodecim. 90:905–912. 1974.

5. 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. 42:43–46. 1975.

6. 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. 107:223–229. 2005.

7. Liliang PC, Tsai YD, Liang CL, Lee TC, Chen HJ. Chronic subdural haematoma in young and extremely aged adults: a comparative study of two age groups. Injury. 33:345–348. 2002.

8. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 54:637–645. 1981.

9. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burrhole craniostomy and closed-system drainage. J Neurosurg. 55:390–396. 1981.

10. Misra M, Salazar JL, Bloom DM. Subdural-peritoneal shunt: treatment for bilateral chronic subdural hematoma. Surg Neurol. 46:378–383. 1996.

11. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol. 47:418–422. 1997.

12. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, et al. Use of drains versus no drains after burrhole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet. 374:1067–1073. 2009.

13. Sim YW, Min KS, Lee MS, Kim YG, Kim DH. A clinical analysis in risk factors of chronic subdural hematoma: focusing on the age. Korean J Neurotrauma. 8:115–121. 2012.

14. Spallone A, Giuffrè R, Gagliardi FM, Vagnozzi R. Chronic subdural hematoma in extremely aged patients. Eur Neurol. 29:18–22. 1989.

15. Svien HJ, Gelety JE. On the surgical management of encapsulated subdural hematoma. A comparison of the results of membranectomy and simple evacuation. J Neurosurg. 21:172–177. 1964.

16. Won YD, Yi HJ, Lee YJ, Chun HJ, Cho H, Bak KH. Chronic subdural hematoma in young adult: an age comparison study. Korean J Neurotrauma. 9:6–11. 2013.

17. Yoshimoto Y, Kwak S. Frontal small craniostomy and irrigation for treatment of chronic subdural haematoma. Br J Neurosurg. 11:150–151. 1997.