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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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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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  • Claudia Unterhofer - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • presenting/speaker Marlies Bauer - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Michael Unterhofer - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
  • Claudius Thomé - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV211

doi: 10.3205/20dgnc207, urn:nbn:de:0183-20dgnc2072

Published: June 26, 2020

© 2020 Unterhofer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.