Chronic subdural hematomas and the elderly: surgical results from a series of 125 cases: Old “horses” are not to be shot!

Detalhes bibliográficos
Autor(a) principal: Silva, Danilo Otávio de Araújo
Data de Publicação: 2012
Outros Autores: Matis, Georgios K., Costa, Leonardo Ferraz, Kitamura, Matheus Augusto Pinto, Carvalho Júnior, Eduardo Vieira de, Silva, Monalisa de Moura, Barbosa, Breno José Alencar Pires, Pereira, Carlos Umberto, Silva Junior, Joacil Carlos da, Birbilis, Theodossios A., Azevedo Filho, Hildo Rocha Cirne de
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFS
Texto Completo: https://ri.ufs.br/handle/riufs/2065
Resumo: Background: To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country. Methods: One hundred and twenty‑five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restauração, Recife‑PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS ≤ 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome. Results: The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS ≥9 on admission presented better outcome (P < 0.05). Recurrent cases presented a poor outcome (P < 0.05). Conclusions: This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.