Objective : To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators. Methods : We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment. Results : The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients. Conclusion : the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.

Introduction Odontoid fractures account for 9% to 15% of adult, cervical spine fractures, and are the most common fractures in the geriatric cervical spine. The mechanism of injury generally results from hyperflexion or hyperextension of the cervical spine during low-energy impacts in the elderly or high-energy impacts in the young and middle aged. No consensus exists on the optimal treatment (surgical or conservative) and the most relevant outcome parameter (osseous union, fracture stability or clinical outcome). Neurologic injuries associated with these fractures are rare. Material and Methods This study was a retrospective chart review of 13 patients who were treated for odontoid process fractures between November 2010 and May 2015. Inclusion criteria: Patients with odontoid fractures submitted to surgical treatment. Data were obtained from medical charts and spinal column imaging reports. Medical charts, imaging studies and the patient's outcomes were submitted to descriptive analysis in the pre-operative and post-operative period. The data submitted to descriptive analysis were: Fracture gaps; the direction and degree of odontoid process displacement; the odontoid fracture line anatomy; the degrees of the atlantoaxial instability; and the contact between the fractured odontoid and the axis vertebrae. We used conventional radiographs, three-dimensional computed tomographic (3D-CT) scans, and magnetic resonance images. We used the Grauer Algorithm for defining the surgical treatment modality. We identified the solid bone union through the presence of bony bridges and the definite continuity of cortical bone. Results A total of 13 patients who underwent surgical treatment for odontoid fracture were identified. The patients were 76.9% men, the mean age = 32.92 years. Traffic accidents (69,2%) were the most common cause of trauma. The main symptom was pain (84.6%) in the posterior cervical region. The elapsed median time from accident to surgery was 30 days. Mean follow-up was 20 months. Odontoid screw technics (38,4%) and Harms posterior technic (38,4%) were the most common surgical treatment adopted as primary surgical treatment. The most common Grauer's line fracture type was type B on 8 cases. 2 patients referred chronic cervical pain after surgery, 1(20%) were submitted to anterior technic and 1 (12,5%) posterior technic. We had 2 cases with complications, all submitted to posterior technic, 1 with CSF leak and 1 with vertebral artery lesion. No mortality was observed. Conclusion There was no difference between anterior or posterior approach when analyzing the cervical chronic pain and mortality. However, there were more complications in cases covered by the posterior approach. A well-designed prospective study with a larger number of cases is needed to better elucidate optimal treatment algorithms from both an outcomes and cost-effectiveness perspective.