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Same procedure every age? The role of craniotomy size in elderly patients with traumatic acute subdural haematoma – A retrospective analysis
Die Rolle der Kraniotomiegröße in alten Patienten mit traumatischen akuten subduralen Hämatomen – eine retrospektive Analyse
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Veröffentlicht: | 26. Juni 2020 |
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Objective: A retrospective study to compare standard (SC) or limited craniotomy (LC) was conducted in elderly patients with a traumatic acute subdural hematoma (aSDH). The aim of this study was to identify the role of craniotomy size in terms of clinical and radiological outcome.
Methods: Between 2000 and 2019, 564 elderly patients were admitted harboring TBI. 69 Patients aged 75 or older with aSDH as sole pathology were retrospectively analyzed. SC was defined as a frontotemporoparietal craniotomy (>8cm) opposed to a temporoparietal craniotomy (<8cm, LC). Data were collected pre-and postoperatively including clinical (GCS) and radiological (hematoma depth (HD) and midline shift (MLS)) criteria. The primary outcome parameter was 30 day mortality. Secondary outcome parameters were radiological: residual HD and residual MLS.
Results: The mean age was 79 (± 3,1) years with no difference between groups. Mortality rate was significantly associated with preoperative HD n= 19,9474±5,79294 (p=0.03) and MLS 14,539±8,1613(p=0.001).A significantly higher mortality rate was found in the SC group n=13 (68,4%)(p=0.045). However, in this group patients scored significantly lower on the initial GCS (p=0.026). The preoperative HD (p=0.08) and the MLS (p=0.09) was significant higher in the SC group.The postoperative residual HD and MLS showed no significant difference between groups.
Conclusion: Size of craniotomy does not influence postoperative radiological outcome in elderly patients with aSDH. A LC is sufficient for adequate hematoma evacuation.