Chronic subdural hematoma: complication avoidance

Shakal, Ahmed; Gamal, Ehab Ezzat El; Farid, Ashraf Mohamed

doi:10.4103/1110-1415.130078

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“…e management of chronic subdural hematoma (CSDH) is completely dependent on the amount of blood, midline shift, and symptomatology. [3,4,9,11,13] Surgical treatment of CSDH is indicated when it causes symptoms such as disturbed consciousness and focal deficits or there is a significant amount of blood compressing the cerebral cortex. [1] e incidence of CSDH increases with age and patients tend to have multiple comorbidities which make the use of general anesthesia (GA) unfavorable.…”

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confidence: 99%

Local anesthesia versus general anesthesia for evacuation of chronic subdural hematoma in elderly patients above 70 years old

Ashry

Al-Shami

Gamal

et al. 2022

Surgical Neurology International

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Background: The aim of this study was to assess the safety and efficacy of chronic subdural hematoma (CSDH) evacuation by two burr-hole craniostomies under local versus general anesthesia (GA) in elderly patients over 70 years. Methods: This retrospective study included 45 patients with CSDH aged over 70 years old treated from March 2018 to April 2020. The cases were subdivided into Group A (n = 22) that underwent evacuation under local anesthesia and Group B (n = 23) that was treated under GA. Patients’ demographics and history of comorbidities were recorded. Variables including pre- and post-operative neurological status and Markwalder’s score, complication rate, operative time, and length of hospital stay were evaluated. Results: The mean and standard deviation of patients’ age of groups (A) and (B) were 74.3 ± 2.5 and 73.2 ± 1.7 years, respectively. Postoperative Glasgow Coma Scale of group (A) was statistically higher than Group B at postoperative day 1 (P = 0.01). Operative time was statistically shorter in Group A than B (P < 0.0001). The length of hospital stay was found to be longer in group (B) than (A) (P = 0.0001). The complication rate was found to be higher in group (B) than (A) (P = 0.044). Conclusion: Evacuation of CSDH under local anesthesia in elderly patients over 70 years is effective, safe, and economic with less complication rate than the traditional technique with GA.

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