gms | German Medical Science

Objective: In neurosurgical practice, the chronic subdural haematoma (CSH) is registered to be the most frequent type of intracranial haemorrhage, observed especially in older patients following mild head injury. This may be the result of an increasing supply and demand for leisure activities for the elderly. In this series, we present our experience in the neurosurgical treatment of CSH in a large cohort with special attention to evaluation of preoperative clinical and radiological factors in the elderly that may influence surgical treatment strategies and outcome.

Methods: 356 patients with symptomatic CSH (225 male, 131 female; mean age 68.3 years), who had been operated on in our neurosurgical department between 1992 and 2003, were included in this retrospective study. We reviewed the charts documenting preoperative clinical status, radiological signs, the history of traumatic events, preoperative status of coagulation, surgical technique, recurrence rate of CSH, operative complications, postoperative clinical status, days of hospitalisation as well as gender and age.

Results: The primary surgical procedure performed in 343 patients (96.4%) was the burr-hole trepanation and implantation of a subdural closed-drainage system. 72 patients underwent a second surgical procedure (20.2%), a third operation became necessary in another 14 patients (3.9%). The leading preoperative symptom was psychomotor retardation (192 patients, 55.8%). We found a strong statistical correlation (p<0.0001) between age, thickness (volume) of the haematoma and deranged coagulation and between the thickness of the haematoma and the symptom "motor deficit". There was a statistically significant correlation (p<0.005) between the thickness of the left-sided haematoma and the symptoms "aphasia" and "behavioural disturbance/psychosyndrome".

Conclusions: We identified mnestic deficits as the leading preoperative clinical finding in our cohort – an early and common symptom found in a variety of age-related diseases. Thus, the CSH should be taken into account in the differential diagnosis besides the other neurodegenerative diseases, especially in geriatric and geronto-psychiatric practices. Our data shows an age-related significant enlargement of the subdural haematoma cavity with a resulting increased volume of the CSH.