Treatment Outcomes of Burr-Hole Surgery for Chronic Subdural Hematoma in the Elderly Living Beyond Life Expectancy: A Study Comparing Cure, Recurrence, and Complications in Patients Aged ≥80 Years versus ≤79 Years

Watanabe, Shinya; Kato, Noriyuki; Sato, Masayuki; Aiyama, Hitoshi; Fujiwara, Yusuke; Goto, Masayuki; Yamazaki, Takahisa; Yasuda, Susumu; Ishikawa, Eiichi; Matsumura, Akira

doi:10.1016/j.wneu.2019.08.003

Cited by 16 publications

(7 citation statements)

References 23 publications

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“…16,[25][26][27] Surgery for CSDHs in the elderly carries unique challenges regarding effectiveness, recurrence rates, surgical complications, and medical perioperative complications. 14,[28][29][30][31][32][33][34][35] A 2018 review of adults older than 65 years (2,831,274 cases in the NSQIP registry and 1,952,305 Medicare beneficiaries) found that the rate of postoperative hematoma recurrence requiring repeat surgery was between 5% and 10%. 36 For example, a Scandinavian population-based multicenter study of 1254 patients undergoing primary burr hole craniotomy found no statistically significant difference between surgical complications, perioperative morbidity, or perioperative mortality in patients older than 90 years versus those younger than 90 years.…”

Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Joyce

Bounajem

Scoville

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe incidence of already common chronic subdural hematomas (CSDHs) and other nonacute subdural hematomas (NASHs) in the elderly is expected to rise as the population ages over the coming decades. Surgical management is associated with recurrence and exposes elderly patients to perioperative and operative risks. Middle meningeal artery (MMA) embolization offers the potential for a minimally invasive, less morbid treatment in this age group. The clinical and radiographic outcomes after MMA embolization treatment for NASHs have not been adequately described in elderly patients. In this paper, the authors describe the clinical and radiographic outcomes after 151 cases of MMA embolization for NASHs among 121 elderly patients.METHODSIn a retrospective review of a prospectively maintained database across 15 US academic centers, the authors identified patients aged ≥ 65 years who underwent MMA embolization for the treatment of NASHs between November 2017 and February 2020. Patient demographics, comorbidities, clinical and radiographic factors, treatment factors, and clinical outcomes were abstracted. Subgroup analysis was performed comparing elderly (age 65–79 years) and advanced elderly (age > 80 years) patients.RESULTSMMA embolization was successfully performed in 98% of NASHs (in 148 of 151 cases) in 121 patients. Seventy elderly patients underwent 87 embolization procedures, and 51 advanced elderly patients underwent 64 embolization procedures. Elderly and advanced elderly patients had similar rates of embolization for upfront (46% vs 61%), recurrent (39% vs 33%), and prophylactic (i.e., with concomitant surgical intervention; 15% vs 6%) NASH treatment. Transfemoral access was used in most patients, and the procedure time was approximately 1 hour in both groups. Particle embolization with supplemental coils was most common, used in 51% (44/87) and 44% (28/64) of attempts for the elderly and advanced elderly groups, respectively. NASH thickness decreased significantly from initial thickness to 6 weeks, with additional decrease in thickness observed in both groups at 90 days. At longest follow-up, the treated NASHs had stabilized or improved in 91% and 98% of the elderly and advanced elderly groups, respectively, with > 50% improvement seen in > 60% of patients for each group. Surgical rescue was necessary in 4.6% and 7.8% of cases, and the overall mortality was 8.6% and 3.9% for elderly and advanced elderly patients, respectively.CONCLUSIONSMMA embolization can be used safely and effectively as an alternative or adjunctive minimally invasive treatment for NASHs in elderly and advanced elderly patients.

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Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Joyce

Bounajem

Scoville

et al. 2020

Neurosurgical Focus

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“…Mauro et al reported similar complication and recovery rates for patients older and younger than 90 years 5) . In contrast, Shinya et al reported that patients older than 80 years were likely to experience a recurrence and required a longer time to be cured 16) . Similarly, Karibe et al compared patients who were older and younger than 70 years and found that the older patients had significantly worse outcomes .…”

Section: Discussionmentioning

confidence: 94%

“…A chronic subdural hematoma (CSDH) is an encapsulated accumulation of blood between the dura mater and arachnoid mater 2,12) . CSDH is a common neurosurgical disease 4,5,11,13,15,16) , and its incidence increases with age 8) . Numerous original studies and reviews have focused on the surgical techniques for CSDH and factors associated with recurrence, however, few studies have focused on CSDH in elderly patients 4,15,16) , despite the increased incidence with age.…”

Section: Introductionmentioning

confidence: 99%

“…CSDH is a common neurosurgical disease 4,5,11,13,15,16) , and its incidence increases with age 8) . Numerous original studies and reviews have focused on the surgical techniques for CSDH and factors associated with recurrence, however, few studies have focused on CSDH in elderly patients 4,15,16) , despite the increased incidence with age. This is particularly concerning because the incidence of CSDH among elderly patients continues to increase as the world population becomes older 1) .…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Subdural Hemorrhage in the Geriatric Population Older Than 80 Years of Age

Oh¹,

Lee²,

Jeon³

et al. 2020

J Korean Soc Geriatr Neurosurg

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Objective: Chronic subdural hematoma (CSDH) is a common neurosurgical disorder, and its incidence increases with age. The aim of this study was to compare the outcomes of elderly and younger patients with CSDH who underwent burr-hole craniotomy. Methods: We retrospectively reviewed the records of 79 patients with unilateral CSDH who underwent burr-hole craniotomy. We compared the data of 28 patients older than 80 years and 51 patients younger than 80 years. Each patient's symptoms, radiologic data, complications, and hospitalization duration were analyzed. Additionally, we evaluated each patient's modified Rankin Scale (mRS) score to assess the clinical outcomes. Results: The mean ages of the older and younger patients were 84.5 and 68.6 years, respectively. Older patients were more likely to develop postoperative complications and remained hospitalized for longer because of complications. Both the preoperative maximal hematoma thickness and the pre-and postoperative difference in thickness were greater in the older group. Preoperatively, the younger group contained a higher percentage of patients with an mRS score of 0-2. Six months postoperatively, both groups had similar percentages of patients with an mRS score of 0-2. Conclusion: Our findings showed that larger hematoma volumes were removed from older group after surgery during similar periods. However, the significantly higher incidence of general complications in the older group led to significantly longer hospitalization. However, the good treatment outcomes and prognosis suggest that burr-hole craniotomy can be an effective treatment even for elderly patients if clinicians remain aware of the prevention and treatment of postoperative complications.

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“…Regarding complication rates, a review of the literature reveals that postoperative complications develop in 4.0 to 37.5% of cases undergoing BHD ( 2 , 3 , 7 , 8 , 21 – 25 ). In the present series, the overall complication rate was 17.3%.…”

Section: Discussionmentioning

confidence: 99%

Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years

et al. 2023

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ObjectiveThe subdural evacuating port system (SEPS) is a minimally invasive approach that can be performed under local anesthesia for the treatment of chronic subdural hematoma (CSDH). Subdural thrombolysis has been described as an exhaustive drainage strategy and found to be safe and effective for improving drainage. We aim to analyze the effectiveness of SEPS with subdural thrombolysis in patients older than 80 years.MethodConsecutive patients aged ≥80 years old who presented with symptomatic CSDH and underwent SEPS followed by subdural thrombolysis between January 2014 and February 2021 were retrospectively studied. Outcome measures included complications, mortality, recurrence, and modified Rankin Scale (mRS) scores at discharge and 3 months.ResultsIn total, 52 patients with CSDH in 57 hemispheres were operated on, with a mean age of 83.9 ± 3.3 years, and 40 (76.9%) patients were men. The preexisting medical comorbidities were observed in 39 patients (75.0%). Postoperative complications occurred in nine patients (17.3%), with two having significant complications (3.8%). The complications observed included pneumonia (11.5%), acute epidural hematoma (3.8%), and ischemic stroke (3.8%). One patient experienced contralateral malignant middle cerebral artery infarction and died of subsequent severe herniation, contributing to a perioperative mortality rate of 1.9%. Discharge and 3 months of favorable outcomes (mRS score 0–3) were achieved in 86.5% and 92.3% of patients, respectively. CSDH recurrence was observed in five patients (9.6%), and repeat SEPS was performed.ConclusionAs an exhaustive drainage strategy, SEPS followed by thrombolysis is safe and effective with excellent outcomes among elderly patients. It is a technically easy and less invasive procedure with similar complications, mortality, and recurrence rates compared with burr-hole drainage in the literature.

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Treatment Outcomes of Burr-Hole Surgery for Chronic Subdural Hematoma in the Elderly Living Beyond Life Expectancy: A Study Comparing Cure, Recurrence, and Complications in Patients Aged ≥80 Years versus ≤79 Years

Cited by 16 publications

References 23 publications

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Middle meningeal artery embolization treatment of nonacute subdural hematomas in the elderly: a multiinstitutional experience of 151 cases

Outcomes of Subdural Hemorrhage in the Geriatric Population Older Than 80 Years of Age

Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years

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