Diagnosis and treatment of chronic subdural hematomas in elderly and senile age patients (own experience and current global trends)

Abstract

Objective ‒ to improve the treatment of chronic subdural hematoma (CSDH) in older people.Materials and methods. Retrospective analysis of the results of diagnosis and treatment of patients with CSDH treated in the Department of Neurotrauma of Romodanov Institute of Neurosurgery NAMS of Ukraine and Zaporizhzhya City Hospital for Emergency and Emergency Medicine in 2010–2019 was performed. The distribution by age was as follows: elderly patients – 80, patients senile age – 32, long-lived – 6. Multislice computed tomography was made in 86.7 % of patients, magnetic resonance imaging ‒ in 13.3 %. In 118 cases different types and volumes of surgical intervention were performed, in 58 ‒ conservative treatment.Results. The indication for surgery in elderly and senile patients with CSDH is the presence of hematoma ≥100 cm3 in the absence of dislocation syndrome. Concomitant somatic diseases were revealed in 95 % of cases. Treatment efficacy was monitored by dynamic magnetic resonance imaging studies (in 73.5 % cases) and multislice computed tomography (in 26.5 %). A comprehensive clinical and neurological examination was performed according to the modified Rankine scale, the Glasgow extended consequences scale, calculation of the Barthel index, after 1, 3 and 6 months. Postoperative complications: CSDH recurrence in 10 (6.0%) patients, mostly older than 60 years, pneumocephalus ‒ in 1 (0.84 %), meningoencephalitis ‒ in 1 (0.84 %) patients. Postoperative mortality was 6.8 % (8 cases). Conclusions. When choosing a method of treatment should be considered etiopathogenetic factors of hematoma formation, the severity of neuroimaging characteristics of CSDH, the degree of displacement of midline structures and neurological symptoms, somatic risks and the patient’s consent. The choice of treatment tactics for the elderly and senile is based not only on the Glasgow consequences scale and Markwalder grading score, but also on the scale of A.K. Thotakura et al. (Displacement of median structures and hematoma density (on the Hounsfield scale)). Removal of the hematoma is the main method of treating CSDH, aspiration of CSDH through burr holes followed by passive drainage is the method of choice. Conservative treatment of CSDH according to clear indications can be used both alone and in combination with surgical treatment.