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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Decompressive craniectomy in acute subdural hematoma: Outcome in a geriatric patients’ population

Meeting Abstract

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  • Andreas Kneist - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Katharina Lischka - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Anna-Christina Groß - Klinik für Dermatologie, Knappschaftskrankenhaus Recklinghausen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 116

doi: 10.3205/14dgnc512, urn:nbn:de:0183-14dgnc5128

Published: May 13, 2014

© 2014 Kneist et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Acute subdural hematoma (aSDH) is a life-threatening condition urging immediate surgery. To assess the role of decompressive craniectomy (DC) in the treatment of aSDH especially in geriatric patients, a retrospective single centre study was conducted with respect to patients' survival and outcome at discharge.

Method: The medical records of 306 patients with aSDH treated between 2004 and 2013 were retrospectively analysed. Patients aged > 75 years receiving DC were included for study purposes. Initial GCS, pupil status, initial computed tomography (CT) scan and INR were obtained from the records as well as GOS on discharge and latest follow-up, if available.

Results: A total of 48 patients were identified meeting inclusion criteria for the present study. Initial GCS was 3-15. 45/48 patients (94%) presented with a midline shift on admission CT. 27 patients (56%) had pupillary anomalies. 32 patients (67%) died despite instant DC. Only three patients reached GOS of 1 or 2 during follow-up, while mean GOS was 3 at discharge and last follow-up.

Conclusions: The overall mortality is high in geriatric patients suffering from aSDH, leaving the majority of survivors with unfavorable outcomes (GOS 3 or 4). In our study, only pupil status and initial GCS were predictive for survival of the patients. DC did not improve the outcome in elderly patients. These data should be taken into account for the indication of an operation.