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Short- and long-term outcome after chronical subdural hematomas by surgical treatment in the very old
Author(s): ,
M.R. Boroumand
Affiliations:
University of Giessen, Neurosurgery, Giessen, Germany
,
E. Uhl
Affiliations:
University of Giessen, Neurosurgery, Giessen, Germany
,
K. Schöller
Affiliations:
University of Giessen, Neurosurgery, Giessen, Germany
,
M. Kolodziej
Affiliations:
University of Giessen, Neurosurgery, Giessen, Germany
,
M. Reinges
Affiliations:
Klinikum Bremen Mitte, Neurosurgery, Bremen, Germany
M. Stein
Affiliations:
University of Giessen, Neurosurgery, Giessen, Germany
EANS Academy. Boroumand R. Oct 21, 2018; 225874; EP5006
Reza Boroumand
Reza Boroumand
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Abstract
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Background: The aim of this study is the evaluation of short-term outcome (STO) and long-term outcome (LTO) of surgically treated cSDH subjected to age and surgical approach.
Methods: This retrospective study enrolled 155 patients with cSDH. Patients were stratified by surgical treatment into one burr hole- (1 BH, n=78), two burr holes- (2 BH, n=39), and craniotomy (n=38) - group. STO was evaluated at hospital discharge. LTO was assessed by standardized questionnaire. Median time between admission and LTO assessment was 3 years (IQR: 2-4) Favorable outcome (FO) was defined as modified Rankin scale (mRs) 0-2.
Results: Median age of the study group was 76 years (IQR: 71-83). 57 patients (36.8%) were 80 years old or older. Median mRs at discharge was 2 (IQR: 1-3). STO was significantly worse with a median mRs of 3 (IQR: 2-4) in patients > = 80 years compared to a median mRS of 2 (IQR: 1-3) for patients < 80 years (P< 0.001).
Median long-term mRs for the survivors was 2 (IQR: 1-3). Regarding the LTO a lower, but not significant, median mRs was detected in patients >= 80 years [3 (IQR: 1-5) vs. 2 (IQR: 0-3), P=0.113]. In the 1 BH group the rate of FO at discharge was significantly lower in patients >=80 years compared to patients < 80 years [9 (26.9%) vs. 38 (76.0%), P< 0.001]. In patients with 2 BH no differences for favorable STO were found. In the craniotomy group no patient with an age >= 80 years had a favorable LTO.
Conclusions: The 2 BH technique reveals good STO and LTO rates in the elderly. For the 1 BH technique a statistically significant effect of age on outcome is only visible at discharge and not in the long-term. Craniotomies for older patients with cSDH should not be the standard procedure.
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