Vyas Nilesh A, Chicoine Michael R
Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Surg Neurol. 2007 Mar;67(3):314-6; discussion 317. doi: 10.1016/j.surneu.2006.03.039. Epub 2006 Oct 6.
Outcomes for elderly patients undergoing craniotomy for evacuation of subdural hematoma (SDH) have been reported to be poor with high mortality rates.
We present the case of a patient who underwent craniotomies at the age of 102 years, and again at the age of 103 years, for acute SDHs with good recovery to her premorbid neurologic condition. A 102-year-old woman presented after falling to the floor, and underwent a left-sided craniotomy for evacuation of a large, left hemispheric acute SDH. She recovered from that event and returned home. Six months later, she presented after falling again and was found to have a large, right hemispheric acute SDH. A right-sided craniotomy was performed and again she made good recovery with return to her neurologic baseline.
We report this unique case of good recovery after 2 separate craniotomies for acute SDH in a patient older than 100 years. Implications of acute SDH in the elderly are discussed, as relevant to this case, with a review of the literature. Although the morbidity and mortality of acute SDH are high, particularly in elderly patients, there is potential for good recovery and excellent outcome in appropriately selected patients.
据报道，老年患者因硬膜下血肿（SDH）行开颅血肿清除术的预后较差，死亡率较高。
我们报告了一例患者，该患者分别在102岁和103岁时因急性硬膜下血肿接受了开颅手术，并恢复到病前的神经功能状态。一名102岁女性跌倒后就诊，因左侧大脑半球急性硬膜下血肿行左侧开颅血肿清除术。她从那次手术中康复并回家。六个月后，她再次跌倒后就诊，被发现患有右侧大脑半球急性硬膜下血肿。于是进行了右侧开颅手术，她再次恢复良好，回到了神经功能基线状态。
我们报告了这例独特的病例，一名100岁以上的患者因急性硬膜下血肿接受了两次开颅手术后恢复良好。结合本病例，讨论了急性硬膜下血肿在老年人中的影响，并对相关文献进行了综述。虽然急性硬膜下血肿的发病率和死亡率很高，尤其是在老年患者中，但在适当选择的患者中仍有恢复良好和获得极佳预后的可能性。
