Operations and re-operations for chronic subdural haematomas during a 25-year period in a well defined population

Abstract

In this retrospective study the hospital records of all patients being operated on for chronic subdural haematomas (CSD) at the Neurosurgical clinic in Lund in the years 1969, 1979, 1989, and 1993 were examined. 218 patients were operated on, 25 of whom had bilateral haematomas. During the 25-year period the incidence of surgically treated CSD rose from 2 to 5.3 per 100,000 inhabitants per year. The mean age (70.5 years) and the relationship males: females (2:1) did not significantly change. The clinical condition of the patients on admission steadily improved during the period. The relative proportion of patients with known chronic alcoholism decreased over the years, but the proportion of patients suffering from other complicating diseases increased, as did the proportion of patients treated with anticoagulants. There was no mortality directly related to surgery, but if defined as deaths within one month after surgery, the overall mortality rate was 3.2%. 84.2% of the patients improved following the first operation, in a majority of cases back to the premorbid state. The relative frequency of re-operations for CSD was 12.3% and did not significantly change during the period. No pre- or peri-operative variable could be identified which could predict who of the patients was at higher risk of re-operation. Surprisingly, the data suggest that the less experienced neurosurgeons had better operative results compared with their older collegues.

Chronic subdural hematoma in the elderly: not a benign disease

“…In their evidence-based review of 48 publications detailing treatment of CSDH, Weigel et al 21 tabulated a composite recurrence rate of 14.6% for all treatment modalities combined. In addition, we also found no relation between premorbid anticoagulant use and the likelihood of lesion recurrence, 6,13,18,20 nor the presence of bilateral subdurals as suggested by others. 20 In keeping with the perception that CSDH is a readily treated condition, the bulk of the neurosurgical literature features only short-term outcome analysis.…”

“…The in-hospital mortality rate of 16.7% modestly exceeds the reported range of 0-15.6%, 1,5,8,13,14,[16][17][18] but many of the more sanguine reports included children, 1,5,14,16 and with a mean age of 80 years, our population is the oldest cohort yet to be reported in the literature. The detrimental effect of diminished mental status at the time of admission on outcome has been previously noted by Gelabert-Gonzalez et al 5 and Rozzelle et al 18 The type of surgical intervention did not impact either the long-or short-term survival, as has also been noted by many authors.…”

“…As GelabertGonzalez et al 5 have stated, CSDHs are perceived as "common lesions that are easily treated with a minimum [sic] morbidity and mortality." The neurosurgical litera-ture primarily focuses therefore on the choice of surgical treatment offered, 3,8,13 the effect of anticoagulants, 6,13,18,20 and whether drains should be left in place.…”

Treatment of chronic subdural hematoma: 5-year clinical experience

“…Recurrence rates were lower in the craniotomy group, only 5% of them underwent reoperations. Age, systemic complications such as cardiovascular and renal diseases in elderly patients, coagulopathy and poor preoperative neurological state are contributory causes of postoperative death (28,57,58). Mortality rate was found 4% in the present study.…”

Brain Stem Hemorrhage Following Burr Hole Drainage for Chronic Subdural Hematoma -Case Report-

“…However, postoperative complications, including cerebral edema, hematoma re-accumulation, subdural empyema, tension pneumocephalus, and intracranial hemorrhage in other sites, have occasionally been reported. 2,11,18,24,25) Intracranial hematomas following burr hole drainage may occur either close to or remote from the original site, but hemorrhage in the brain stem secondary to the surgery is extremely rare. 2,4,8,14) We treated a 76-yearold man who suffered brain stem hemorrhage after bilateral CSDH evacuation, who fortunately recovered with only mild gait disturbance.…”