Koller Anna, Reich Christoph, Thomé Claudius, Pinggera Daniel
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
Brain Spine. 2025 Sep 6;5:105602. doi: 10.1016/j.bas.2025.105602. eCollection 2025.
Acute subdural hematoma (aSDH) is a severe condition with high mortality despite advances in neurosurgical care. Predicting outcomes remains challenging due to individual variability. This study explores sex- and age-related differences in surgical treatment and outcomes of aSDH.
How does sex and age influence surgical decision-making and outcomes in patients undergoing surgery for acute subdural hematoma?
We retrospectively analyzed 328 patients treated surgically for aSDH between 2005 and 2015. Demographic data, clinical characteristics (GCS), radiological parameters, surgical approach (osteoplastic craniotomy [OC] vs. decompressive craniectomy [DC]), and outcomes (Glasgow Outcome Scale [GOS]) at discharge were collected.
The cohort included 211 men (mean age: 56) and 117 women (mean age: 68). Hematoma volumes were similar between sexes (p = 0.9), yet surgical choices differed significantly (OC in 58 % of women vs. 43 % of men; p = 0.008). Elderly patients (>70 years; n = 133) had larger hematoma volumes than younger patients (64.6 vs. 44.8 cm; p < 0.0001) and were more frequently treated with OC (68 % vs. 35 %; p < 0.0001). Age and hematoma volume-but not sex-were independent predictors of surgical approach. Outcome (GOS) was worse in elderly patients (p < 0.001) and those undergoing DC (p = 0.001). Time to CT correlated with outcome (p = 0.001), while time to surgery did not.
Despite comparable hematoma volumes, surgical strategies varied by sex and age. Elderly patients with larger hematomas were less likely to receive DC. These findings highlight demographic influences on surgical decision-making and support a more individualized approach in managing aSDH.
尽管神经外科治疗取得了进展，但急性硬膜下血肿（aSDH）仍是一种严重疾病，死亡率很高。由于个体差异，预测预后仍然具有挑战性。本研究探讨了aSDH手术治疗及预后方面与性别和年龄相关的差异。
性别和年龄如何影响急性硬膜下血肿手术患者的手术决策和预后？
我们回顾性分析了2005年至2015年间接受aSDH手术治疗的328例患者。收集了人口统计学数据、临床特征（格拉斯哥昏迷量表 [GCS]）、影像学参数、手术方式（骨成形性开颅术 [OC] 与减压性颅骨切除术 [DC]）以及出院时的预后（格拉斯哥预后量表 [GOS]）。
该队列包括211名男性（平均年龄：56岁）和117名女性（平均年龄：68岁）。两性之间血肿体积相似（p = 0.9），但手术选择差异显著（58% 的女性选择OC，而男性为43%；p = 0.008）。老年患者（>70岁；n = 133）的血肿体积大于年轻患者（64.6 vs. 44.8 cm；p < 0.0001），且更常接受OC治疗（68% 对35%；p < 0.0001）。年龄和血肿体积——而非性别——是手术方式的独立预测因素。老年患者（p < 0.001）和接受DC治疗的患者（p = 0.001）预后（GOS）较差。CT检查时间与预后相关（p = 0.001），而手术时间与预后无关。
尽管血肿体积相当，但手术策略因性别和年龄而异。血肿较大的老年患者接受DC治疗的可能性较小。这些发现突出了人口统计学对手术决策的影响，并支持在管理aSDH时采用更个体化的方法。
