Munoz-Bendix Christopher, Pannewitz Robert, Remmel Daniel, Steiger Hans-Jakob, Turowski Bernd, Slotty Phillip Jorg, Kamp Marcel Alexander
Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
Institute for Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
Neurosurg Rev. 2017 Jul;40(3):461-468. doi: 10.1007/s10143-016-0803-y. Epub 2016 Dec 28.
As a result of the demographic shift in western societies, the mean age at presentation of patients suffering from chronic subdural hematomas (cSDH) is increasing. Therapeutic strategies, surgical and non-surgical, need to be reevaluated and adapted accordingly. Age is considered to be a positive risk factor for a higher perioperative morbidity and mortality. The purpose of this study is to determine if old age (≥85 years) should be seen as a contraindication for surgical treatment. Two groups (56 patients each) with cSDH over and below 85 years of age from a single neurosurgical department with well-defined surgical treatment guidelines were retrospectively analyzed. Clinical characteristics of the patients, localization, treatment, prior medication, and complications were compared. Outcome was measured by clinical improvement postoperatively and by the Glasgow Outcome Scale (GOS) at 1 month after surgery. Age ≥85 years was associated with higher GOS 1 month after surgery (p = 0.038). 51.8% (58) of all patients had a complete neurological recovery postoperatively, and 74% (43) of these patients were ≥85 years. Elderly patients suffered from a significantly higher complication rate (p < 0.001) with odds of having a complication 18.3 times higher (p < 0.001) compared to patients <85 years. Both groups had a comparable mean hospitalization time (9.8 days for patients ≥85 years and 9.5 days for patients <85 years). Old age has no negative impact on overall outcome after surgical therapy of cSDH. Despite significantly higher complication rate in elderly patients, the outcome assessed by the GOS at 1 month after surgery was significantly better in comparison to patients younger than 85 years. Old age does therefore not seem to be a contraindication for surgical treatment of cSDH.
由于西方社会的人口结构变化，慢性硬膜下血肿（cSDH）患者的就诊平均年龄在增加。手术和非手术治疗策略都需要重新评估并相应调整。年龄被认为是围手术期发病率和死亡率较高的一个正向风险因素。本研究的目的是确定高龄（≥85岁）是否应被视为手术治疗的禁忌症。对来自单一神经外科科室、具有明确手术治疗指南的两组cSDH患者（每组56例）进行回顾性分析，一组年龄超过85岁，另一组年龄低于85岁。比较了患者的临床特征、血肿位置、治疗方法、既往用药情况及并发症。通过术后临床改善情况以及术后1个月的格拉斯哥预后量表（GOS）来衡量治疗结果。术后1个月时，年龄≥85岁的患者GOS评分较高（p = 0.038）。所有患者中有51.8%（58例）术后神经功能完全恢复，其中74%（43例）患者年龄≥85岁。老年患者的并发症发生率显著更高（p < 0.001），与年龄<85岁的患者相比，发生并发症的几率高18.3倍（p < 0.001）。两组的平均住院时间相当（年龄≥85岁的患者为9.8天，年龄<85岁的患者为9.5天）。高龄对cSDH手术治疗后的总体预后没有负面影响。尽管老年患者的并发症发生率显著更高，但与年龄小于85岁的患者相比，术后1个月通过GOS评估的预后明显更好。因此，高龄似乎不是cSDH手术治疗的禁忌症。
