Department of Neurosurgery, Johann Wolfgang Goethe-University Frankfurt am Main, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
Acta Neurochir (Wien). 2012 Sep;154(9):1549-54. doi: 10.1007/s00701-012-1434-x. Epub 2012 Jul 8.
Chronic subdural haematoma (cSDH) is a common disease in neurosurgical practise, especially in elderly patients. This is of growing importance as the number of elderly people in the population is increasing steadily. There are scarce data focussing especially on elderly patients with cSDH. This study intended to evaluate the outcome and peri-operative risks in elderly patients with cSDH.
We retrospectively reviewed medical records of 322 consecutive patients aged ≥65 years treated at our department between 2002 and 2009 focussing on outcome, aetiology, peri-operative risks, recurrence rate, and co-factors such as concomitant diseases and therapy with anticoagulants. The surgical procedure included burr-hole craniostomy followed by insertion of a subdural drain in each case. The outcome was classified according to the Karnofsky performance status (KPS) and modified Rankin Scale (mRS) score. Patients were divided into three groups according to age (group I: age 65-74 years, group II: 75-84 years, group III: 85-94 years).
Three hundred twenty-two patients underwent burr-hole craniostomy for cSDH in 399 surgical procedures. The mean age was 76 ± 7.9 years. After surgery, the mean neurological status improved in all three groups. Overall favourable outcome (mRS 0-2) was achieved in 83 % in group I, 68 % in group II and 51 % in group III, respectively. The rate of recurrence was lower in group III (7.5 %) compared to groups I (21.5 %) and II (27.37 %, p = 0.004). Overall, complication rates and peri-operative mortality (2.75 %) did not differ significantly between the age groups.
The data of the current study suggest that treatment of cSDH is safe in elderly patients. Patients aged above 85 years carry a greater risk for peri-operative complications, i.e. aSDH, and therefore have to be examined and monitored meticulously in order to prevent complications.
慢性硬脑膜下血肿（cSDH）是神经外科实践中的一种常见疾病，特别是在老年患者中。随着人口中老年人数量的稳步增加，这种疾病的重要性日益增加。目前很少有数据专门针对患有 cSDH 的老年患者。本研究旨在评估老年 cSDH 患者的治疗效果和围手术期风险。
我们回顾性分析了 2002 年至 2009 年间在我院接受治疗的 322 例年龄≥65 岁的连续患者的病历，重点关注结局、病因、围手术期风险、复发率以及合并症（如伴随疾病）和抗凝治疗等因素。手术方法包括颅骨钻孔术，然后在每个病例中插入硬膜下引流管。根据卡诺夫斯基表现状态（KPS）和改良的 Rankin 量表（mRS）评分对结果进行分类。患者根据年龄分为三组（I 组：65-74 岁；II 组：75-84 岁；III 组：85-94 岁）。
322 例患者共进行了 399 次颅骨钻孔术治疗 cSDH。平均年龄为 76±7.9 岁。术后，三组患者的平均神经功能均有所改善。I 组、II 组和 III 组的总体预后良好（mRS 0-2）分别为 83%、68%和 51%。III 组的复发率（7.5%）明显低于 I 组（21.5%）和 II 组（27.37%），差异有统计学意义（p=0.004）。总的来说，各年龄组之间的并发症发生率和围手术期死亡率（2.75%）无显著差异。
本研究数据表明，老年患者 cSDH 的治疗是安全的。年龄在 85 岁以上的患者发生围手术期并发症（如急性硬膜下血肿）的风险更高，因此需要仔细检查和监测，以预防并发症。
