Endoscopic Hematoma Evacuation for Acute Subdural Hematoma in the Elderly: A Preliminary Study

Aim. Endoscopic surgery for acute subdural hematoma (ASDH) has recently been performed in elderly patients. Unlike other reported procedures, we used the endoscope’s fixation device to ensure hemostasis because the surgeon can then use a surgical instrument with each hand. To date, there have no reports that prove lesser invasiveness or noninferiority of endoscopic surgery based on direct comparison with a large craniotomy. In this study, we investigated whether our endoscopic procedure was effective and safe. Materials and Methods. We performed 6 cases of endoscopic surgical procedures in elderly patients over the past year. First, our surgical outcomes were evaluated. Second, the outcomes were compared between our endoscopic surgery and our large craniotomy procedures. Third, the outcomes were compared between our endoscopic surgery and other reported endoscopic surgeries. Results. The outcomes of our endoscopic surgery were generally satisfactory without complications or rebleeding. Mean hematoma evacuation percentage was 91.6 ± 4%. Compared with a large craniotomy, operative time was significantly shorter ( P = .01), and the hospital costs were significantly less for endoscopic surgery ( P = .008). There was no inferiority of outcomes when compared with other reported endoscopic surgeries. Conclusion. Our surgical procedure is safe and effective when performed with strict operative indications. Endoscopic surgery for ASDH in elderly adults may be an alternative to a large craniotomy in simple-type hematomas.

Download Full-text

Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly

The American Surgeon ◽

10.1177/00031348211056279 ◽

2021 ◽

pp. 000313482110562

Author(s):

Tarik Wasfie ◽

Nicholas Fitzpatrick ◽

Mursal Niasan ◽

Jennifer L. Hille ◽

Raquel Yapchai ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Anticoagulant Therapy ◽

Subdural Hematoma ◽

Significant Risk ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Acute Subdural Hematoma ◽

Mortality Data ◽

Group A

Introduction Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. Methods A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ .05. Institutional review board approval was obtained for this study. Results There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors ( P < .05). Conclusion Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.

Download Full-text

Risk Factors Contributing to Higher Mortality Rates in Elderly Patients with Acute Traumatic Subdural Hematoma Sustained in a Fall: A Cross-Sectional Analysis Using Registered Trauma Data

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112426 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2426 ◽

Cited By ~ 1

Author(s):

Ching-Hua Hsieh ◽

Cheng-Shyuan Rau ◽

Shao-Chun Wu ◽

Hang-Tsung Liu ◽

Chun-Ying Huang ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Elderly Patients ◽

Subdural Hematoma ◽

Odds Ratio ◽

The Elderly ◽

Mortality Rates ◽

Acute Subdural Hematoma ◽

Hematoma Volume ◽

Independent Risk Factors

Background: We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Mortality rates of the elderly were compared to those of young adults. Methods: A total of 444 patients with acute traumatic subdural hematoma resulting from a fall, admitted to a level I trauma center from 1 January 2009 to 31 December 2016 were enrolled in this study. Patients were categorized into two groups: elderly patients (n = 279) and young adults (n = 165). The primary outcome of this study was patient mortality in hospital. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for mortality was calculated according to gender and pre-existing comorbidities. Univariate and multivariate logistic regression analyses were performed to identify factors related to mortality in the elderly. Results: The odds ratio for mortality caused by falls in the elderly patients was four-fold higher than in the young adults, after adjusting for gender and pre-existing comorbidities. In addition, the presence of pre-existing coronary artery disease (OR 3.2, 95% CI 1.09–9.69, p = 0.035), end-stage renal disease (OR 4.6, 95% CI 1.48–14.13, p = 0.008), hematoma volume (OR 1.2, 95% CI 1.11–1.36, p < 0.001), injury severity score (OR 1.3, 95% CI 1.23–1.46, p < 0.001), and coagulopathy (OR 4.0, 95% CI 1.47–11.05, p = 0.007) were significant independent risk factors for mortality in patients with acute traumatic SDH resulting from a fall. Conclusions: In this study, we identified that pre-existing CAD, ESRD, hematoma volume, ISS, and coagulopathy were significant independent risk factors for mortality in patients with acute traumatic SDH. These results suggest that death following acute SDH is influenced both by the extent of neurological damage and the overall health of the patient at the time of injury.

Download Full-text

Optimal surgical indications of endoscopic surgery for traumatic acute subdural hematoma in elderly patients based on a single-institution experience

Neurosurgical Review ◽

10.1007/s10143-020-01351-x ◽

2020 ◽

Author(s):

Koichi Miki ◽

Masani Nonaka ◽

Hiromasa Kobayashi ◽

Yoshinobu Horio ◽

Hiroshi Abe ◽

...

Keyword(s):

Elderly Patients ◽

Endoscopic Surgery ◽

Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Surgical Indications ◽

Single Institution

Download Full-text

Endoscopic hematoma evacuation for acute and subacute subdural hematoma in elderly patients

Journal of Neurosurgery ◽

10.3171/2014.10.jns14915 ◽

2015 ◽

Vol 123 (4) ◽

pp. 1065-1069 ◽

Cited By ~ 17

Author(s):

Kimihiko Yokosuka ◽

Masaaki Uno ◽

Kohei Matsumura ◽

Hiroki Takai ◽

Hirotaka Hagino ◽

...

Keyword(s):

Elderly Patients ◽

Scale Score ◽

Endoscopic Surgery ◽

Subdural Hematoma ◽

Clinical Symptoms ◽

Operation Time ◽

Intracerebral Hematoma ◽

Hematoma Evacuation ◽

Invasive Method ◽

The Mean

OBJECT Endoscopic surgery was performed for acute or subacute subdural hematoma (SDH), and its effectiveness and safety in elderly patients were evaluated. METHODS Between September 2007 and November 2013, endoscopic surgery was performed in 11 elderly patients with acute SDH (8 patients) and subacute SDH (3 patients). The criteria for surgery were as follows: 1) the presence of clinical symptoms; 2) age older than 70 years; 3) no brain injury (intracerebral hematoma, brain contusion); 4) absence of an enlarging SDH; and 5) no high risk of bleeding. Hematoma evacuation was performed with a 4-mm rigid endoscope with a 0° lens and a malleable irrigation suction cannula. RESULTS Endoscopic surgery was performed under local anesthesia. The mean age of the patients was 82.6 years (range 73–91 years). There were 5 female and 6 male patients. The mean preoperative Glasgow Coma Scale score was 12, and 5 patients had been receiving antithrombotic drug therapy. The mean operation time was 85 minutes. Only 1 patient had rebleeding, and reoperation with the same technique was performed uneventfully in this individual. A total of 7 patients had a good recovery (modified Rankin Scale Score 0–2) at discharge. CONCLUSIONS Endoscopic hematoma evacuation of acute and subacute SDH is a safe and effective method of clot removal that minimizes operative complications. This technique may be a less invasive method for treating elderly patients with acute and subacute SDHs.

Download Full-text