gms | German Medical Science

Objective: Chronic subdural hematoma (CSDH) is a frequently seen disease in neurosurgical practice. The treatment consists of a neurosurgical evacuation of the hematoma and is assumed to be easily performed. However, a considerable number of patients suffers from a recurrence or an unfavorable outcome. Aim of this study was to identify patient cohorts who bear a high risk of developing such an unfavorable outcome after treatment of a CSDH.

Methods: The clinical course of patients with CSDH who were consecutively treated in our institution between June 2006 and June 2011 was analyzed retrospectively by obtaining data from the patient charts. Questionnaires and telephone interviews were used to achieve additional information. The standard neurosurgical procedure was a single burr hole with insertion of a drainage.

Results: 249 patients were operated on a CSDH in our department between June 2006 and June 2011, whereof 201 patients were available for follow-up. 61 (30.3%) of the patients were female and 140 (69.7%) male with a median age of 74 years (25–95). An adequate trauma was remembered in only 85 (42.3%) cases. Initial symptoms were headache (n = 58), focal neurological deficit (n = 98), impaired consciousness (n = 37) and seizures (n = 5). 84 (41.8%) of the patients were treated with anticoagulation medication at time of admission. A recurrence of hematoma was operated on in 37 (18.4%) of the patients. After a median follow-up of 51 (2–242) weeks, a poor outcome, defined as 4–6 on the modified Rankin Scale (mRS), was seen in 37 (18.4%) of the patients. Patients with a good outcome (mRS 0–3) were significant younger at the point of time of operation than those with a bad outcome (Mann-Whitney Rank Sum Test, p < 0.001). The intake of anticoagulants before admission was significantly associated with a bad outcome (logistic regression analysis, p = 0.04, Odds ratio (OR) 2.1, 95% Confidence interval (CI) 1.0–4.3), whereas the recurrence of an CSDH by itself did not lead to an unfavorable outcome (p = 0.59, OR 1.2, 95% CI 0.53–3.1). The presence of focal neurological deficits or a consciousness disturbance as initial symptoms did not affect the outcome significantly as well (p = 0.13, OR 1.9, 95% CI 0.82–4.83).

Conclusions: The intake of anticoagulants prior to admission increases the risk of an unfavorable outcome in patients with CSDH but not the presence of a recurrent hematoma. The anticoagulants might be an indicator for pre-existing underlying diseases that are co-factor for the outcome.