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61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Outcome and peri-operative risks in elderly patients with chronic subdural haematoma: a retrospective analysis of 322 patients between the ages 65–94 years

Meeting Abstract

  • Valeri Borger - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
  • Erdem Güresir - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
  • Ági Oszvald - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
  • Gerhard Marquardt - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
  • Hartmut Vatter - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland
  • Volker Seifert - Klinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1691

DOI: 10.3205/10dgnc162, URN: urn:nbn:de:0183-10dgnc1623

Veröffentlicht: 16. September 2010

© 2010 Borger et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Chronic subdural haematoma (cSDH) is a common disease seen in neurosurgical practise, especially in elderly patients. This is of growing importance as the number of elderly people in the population increases steadily. This study intended to evaluate the peri-operative risks and outcome in elderly patients with chronic subdural haematoma.

Methods: A retrospective analysis was performed by reviewing medical records. From 2002 to 2009 401 cases treated with burr hole craniostomy and closed-system drainage were evaluated with respect to cause of haemtoma, symptoms, concomittant diseases, postoperative complications, recurrent incidents and outcome (Karnofsky performance score and modified Rankin scale score) at discharge of patients. Patients were divided into three groups regarding to age (group I: age 65–74 years, group II: 75–84 years, group III: 85–94 years).

Results: The analysis revealed trauma as the major cause for cSDH. At the time of diagnosis, 37% (group I), 40.6% (group II) and 52.8% (group III) of patients were treated with anticoagulant drugs. Patients in group I mainly suffered headache (33,7 %) and hemiparesis (29.8%), whereas patients in group II reported hemiparesis (38.2%) and aphasia (14.5%). The patients in group III suffered primarily hemiparesis (34%), aphasia (30.2%) as well as alterations in mental state (15.1%). Concomittant diseases were hypertension (group I and II) and coronary artery disease (group II and III). The postoperative complications included aSDH (group I: 1.1%, group II: 2.4%, group III: 5.7%) and ICH (group I: 2,2 %, group II: 0.6%, group III: 0%). The recurrent incidence rate was 21.5% in group I, 27.3% in group II and 7.5% in group III. The outcome measured by KPS before suffering cSDH / with cSDH / at discharge after treatment of cSDH was 90/80/90 (group I), 80/70/80 (group II) and 80/50/70 (group III).

Conclusions: Burr hole trepanation is safe in elderly patients as in the younger group despite higher rates of anticoagulation and multimorbidity. However patients aged above 85 years suffer a greater risk for postoperative aSDH.

At discharge patients belonging to group I and group II are able to acquire the same KPS level as before the event of cSDH, whereas patients in group III show a decreased KPS level. As a consequence a careful approach and postoperative monitoring is of great importance especially in the elderly patients.