Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

ABSTRACT Background: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

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Endoscopic evacuation of septated chronic subdural hemorrhage – Technical considerations, results, and outcome

Surgical Neurology International ◽

10.25259/sni_963_2021 ◽

2022 ◽

Vol 13 ◽

pp. 8

Author(s):

Harnarayan Singh ◽

Rana Patir ◽

Sandeep Vaishya ◽

Rahul Miglani ◽

Anurag Gupta ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Subdural Hemorrhage ◽

Subdural Space ◽

Subdural Bleeding ◽

Endoscopic Evacuation ◽

Clinically Significant ◽

Burr Holes

Background: Chronic subdural hematoma (cSDH) is a common entity in the elderly. Homogeneous or well-liquefied CSDH has a standard line of treatment through burr hole and irrigation. However, the management of septated chronic subdural hematoma (sCSDH) with multiple membranes does not have a well-defined surgical approach. The neomembranes forming septations prevent evacuation of clots through burr holes, and the small remaining loculi with clots will enlarge overtime to cause recurrence. Methods: Patients with sCSDH were operated through a minicraniotomy (2.5 cm × 2.5 cm) using rigid endoscopes for visualization of the subdural space. Using endoscope, the entire subdural space can be visualized. The neomembranes are removed with standard neurosurgical microinstruments. The entire cavity is irrigated under vision to remove all clots and ensures hemostasis. Results: Eighty-three endoscope-assisted evacuations were done in 68 patients from January 2016 to April 2020. Fifty (73.5%) patients had unilateral and 18 (26.5%) had bilateral subdural. Only 1 patient (1.47%) had a clinically significant recollection of subdural bleeding 1 month after the procedure. Over a mean follow-up period of 25.3 months (range 1–53 months), rest of patients did not show any recollection. Conclusion: Endoscopic evacuation of sCSDH is a safe and effective method and can be used to improve clot evacuation, and remove neomembranes under direct vision to reduce the rates of recollection. This method also obviates the need for larger craniotomies to remove membranes.

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Rotator cuff tears: functional outcomes of open surgery

10.21203/rs.3.rs-19333/v1 ◽

2020 ◽

Author(s):

Zafer Volkan Gokce

Keyword(s):

Rotator Cuff ◽

Functional Outcomes ◽

Tendon Healing ◽

The Elderly ◽

Rotator Cuff Tears ◽

Functional Assessments ◽

Before And After ◽

Correlation Tests ◽

Cuff Repair

Abstract Background: The aim of the present study was to evaluate the clinical and radiological outcomes of the patients who underwent open surgical repair with the diagnosis of rotator cuff rupture. Methods: Twenty-eight rotator cuff tear patients refractory to conservative treatment and underwent open rotator cuff repair between April 2012 and April 2017 were retrospectively included in the study. Patients were assessed radiologically and clinically before and after surgery. Patients' age, gender, duration of complaints, the type of the rupture, the data obtained during operation (rupture size, shape, affected tendon, the presence of retraction if any), postoperative complications were recorded. Functional assessments of the patients were performed at 6th and 12th months preoperatively and postoperatively with objective assessments using Constant and UCLA scoring. All patients' operated shoulders were evaluated with MRI during their recent follow-up. Results: The mean postoperative follow-up period of the patients was 30.4 (range: 13-72) months. Preoperative and postoperative mean UCLA scores of the patients were 10.85±1.89, and 28.8±3.34, respectively (p < 0.001). Pre-, and postoperative average Constant scores were 38.1 (range, 7.0 to 56.0), and 72.4 (range, 52.0 to 98.0), respectively (p < 0.001). Rotator cuff continuity was assessed in shoulder MRIs obtained during recent follow-ups of patients, and four recurrent tears were observed. Correlation tests revealed that tear size observed during surgery showed a significant (p = 0.002) and a weakly negative (r = -0.468) correlation with preoperative Constant scores, and a significant (p = 0.0001) and moderately negative (r = -0.645) relationship with postoperative Constant scores. UCLA and Constant functional outcomes were worse in patients over 60 years of age, than younger patients and recurrent tears were more often observed in the elderly population. A significant relationship was revealed between the age of the patients and tendon healing (p < 0.05). Conclusion: The results of this study suggest that open repair is a reasonable and successful treatment option in patients with rotator cuff tears. Overall satisfactory clinical outcomes could be achieved.

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Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Neurosurgical FOCUS ◽

10.3171/2017.7.focus17417 ◽

2017 ◽

Vol 43 (5) ◽

pp. E10 ◽

Cited By ~ 16

Author(s):

Sae-Yeon Won ◽

Daniel Dubinski ◽

Nina Brawanski ◽

Adam Strzelczyk ◽

Volker Seifert ◽

...

Keyword(s):

Surgical Treatment ◽

Functional Outcome ◽

Subdural Hematoma ◽

Clinical Status ◽

The Elderly ◽

Favorable Outcome ◽

Acute Subdural Hematoma ◽

Common Disease ◽

Gcs Score

OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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Single versus Double Burr Holes for Treating Chronic Subdural Hematoma

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i2.44882 ◽

2020 ◽

Vol 9 (2) ◽

pp. 99-104

Author(s):

Uzzal Kumer Sadhu Khan ◽

Asit Chandra Sarker ◽

Md Mahamudul Haq Morshed ◽

Md Motasimul Hasan ◽

Saiful Hoque ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Cerebral Atrophy ◽

The Elderly ◽

Burr Hole ◽

Group A ◽

Group B ◽

Burr Holes ◽

Better Than

A subdural hematoma is a collection of blood below the inner layer of the dura but external to the bran and arachnoid membrane.Chronic subdural hematoma is commonly associated with cerebral atrophy, occur in the elderly after apparently insignificant head trauma. The incidence of Chronic subdural hematoma increases with age and after 70 years of age. Surgical evacuation of hematoma is indicated in patients who are clinically deteriorate or do not improve. Surgery can bring a rapid clinical improvement with a favorable outcome in over 80% of patient. Methods: This study was a prospective intervention study. Results: It was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B in GOS scoring on the 7th POD. The alive patients were again divided into 4 sub groups, as shown in the table. Among total 60 patients, in Group A 1(3.4%) died and 3 (10.0%) died in Group B. After 3 months follow up, it was observed that 29 (96.6%) patients were alive in group A and 27 (90.0%) patients alive in group B. The alive patients were again divided into 4 sub groups, as shown in the table. Persistent vegetative and severe disability was not improved in Group B. Conclusion: In my study it was observed that the surgical outcome in single burr hole craniotomy is better than double burr hole craniotomy for treating of chronic subdural hematoma. Bang. J Neurosurgery 2020; 9(2): 99-104

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Acute subdural haematoma in the elderly: to operate or not to operate? A systematic review and meta-analysis of outcomes following surgery

BMJ Open ◽

10.1136/bmjopen-2021-050786 ◽

2021 ◽

Vol 11 (12) ◽

pp. e050786

Author(s):

Susruta Manivannan ◽

Robert Spencer ◽

Omar Marei ◽

Isaac Mayo ◽

Omar Elalfy ◽

...

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Subdural Haematoma ◽

Surgical Intervention ◽

Meta Analysis ◽

The Elderly ◽

Neurological Status ◽

Acute Subdural Haematoma ◽

Level Of Evidence

ObjectivesAcute subdural haematoma (ASDH) is a devastating pathology commonly found on CT brain scans of patients with traumatic brain injury. The role of surgical intervention in the elderly has been increasingly questioned due to its associated morbidity and mortality. Therefore, a systematic review and meta-analysis of the literature to quantify the mortality and functional outcomes associated with surgical management of ASDH in the elderly was performed.Design/settingA multidatabase literature search between January 1990 and May 2020, and meta-analysis of proportions was performed to quantify mortality and unfavourable outcome (Glasgow Outcome scale 1–3; death/ severe disability) rates.ParticipantsStudies reporting patients aged 60 years or older.InterventionsCraniotomy, decompressive craniectomy, conservative management.Outcome measuresMortality and functional outcomes (discharge, long-term follow-up (LTFU)).Results2572 articles were screened, yielding 21 studies for final inclusion and 15 for meta-analysis. Pooled estimates of mortality were 39.83% (95% CI 32.73% to 47.14%; 10 studies, 308/739 patients, I2=73%) at discharge and 49.30% (95% CI 42.01% to 56.61%; 10 studies, 277/555 patients, I2=63%) at LTFU. Mean duration of follow-up was 7.1 months (range 2–12 months). Pooled estimate of percentage of poor outcomes was 81.18% (95% CI 75.61% to 86.21%; 6 studies, 363/451 patients, I2=45%) at discharge, and 79.25% (95% CI 72.42% to 85.37%; 8 studies, 402/511 patients, I2=66%) at LTFU. Mean duration of follow-up was 6.4 months (range 2–12 months). Potential risk factors for poor outcome included age, baseline functional status, preoperative neurological status and imaging parameters.ConclusionsOutcomes following surgical evacuation of ASDH in patients aged 60 years and above are poor. This constitutes the best level of evidence in the current literature that surgical intervention for ASDH in the elderly carries significant risks, which must be weighed against benefits.PROSPERO registration numberCRD42020189508.

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Management and outcome of traumatic subdural hematoma in 47 infants and children from a single center

Wiener klinische Wochenschrift ◽

10.1007/s00508-020-01648-3 ◽

2020 ◽

Vol 132 (17-18) ◽

pp. 499-505

Author(s):

Harald Binder ◽

Thomas M. Tiefenboeck ◽

Marek Majdan ◽

Micha Komjati ◽

Rupert Schuster ◽

...

Keyword(s):

Subdural Hematoma ◽

Functional Outcomes ◽

Neurological Status ◽

Neurological Impairment ◽

Infants And Children ◽

Adequate Treatment ◽

Neurological Outcomes ◽

Choice Of Treatment ◽

Children And Adolescence

Summary Background Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. It is hypothesized, that with the adequate treatment of SDH in children and adolescence, excellent clinical and functional outcomes can be achieved. The aim of this study was to present the severity and outcome of traumatic SDH in children and adolescence as well as to analyze differences between patients treated surgically and conservatively. Methods In this study 47 infants and children with a subdural hematoma (SDH) were treated between 1992 and 2010 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow outcome scale (GOS) scores at hospital discharge and at follow-up visits were used. Severity of SDH was classified according to the Rotterdam score. Results In total, 47 cases were treated (21 surgically, 26 conservatively), with 10 patients needing delayed surgery. Overall, 89% of the patients were able to leave hospital, 5 patients died, 2 patients (5%) within 24 h, another 2 (5%) after 48 h and 1 (2%) within 7 days. In 25 patients (53%) a good recovery was recorded at the last follow-up visit. Outcome was mainly influenced by the following factors: age, severity of TBI, and neurological status. Overall, in 70% good clinical and neurological outcomes could be achieved. Conclusion The results of this study confirmed that pediatric SDH is a rare, but serious condition. Despite a poor prognosis, most patients could be treated with good outcomes, given that the choice of treatment is correct. Trial registration Research registry 2686

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Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

Romanian Neurosurgery ◽

10.1515/romneu-2017-0002 ◽

2017 ◽

Vol 31 (1) ◽

pp. 8-16

Author(s):

D. Adam ◽

D. Iftimie ◽

Gina Burduşa ◽

Cristiana Moisescu

Keyword(s):

Conservative Treatment ◽

Subdural Hematoma ◽

Clinical Presentation ◽

Surgical Intervention ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Neurological Status ◽

Spontaneous Resolution ◽

Subdural Hematomas ◽

Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

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Chronic subdural hematoma in the elderly: not a benign disease

Journal of Neurosurgery ◽

10.3171/2010.8.jns10298 ◽

2011 ◽

Vol 114 (1) ◽

pp. 72-76 ◽

Cited By ~ 154

Author(s):

Lucas Bernardes Miranda ◽

Ernest Braxton ◽

Joseph Hobbs ◽

Matthew R. Quigley

Keyword(s):

Mortality Rate ◽

Median Survival ◽

Subdural Hematoma ◽

Excess Mortality ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Benign Disease ◽

Twist Drill ◽

Chi Square Analysis

Object Chronic subdural hematoma (CSDH) is perceived to be a “benign,” easily treated condition in the elderly, but reported follow-up periods are brief, usually limited to acute hospitalization. Methods The authors conducted a retrospective review of data obtained in a prospectively identified consecutive series of adult patients admitted to their institution between September 2000 and February 2008 and in whom there was a CT diagnosis of CSDH. Survival data were compared to life-table data. Results Of the 209 cases analyzed, 63% were men and the mean age was 80.6 years (range 65–96 years). Primary surgical interventions performed were bur holes in 21 patients, twist-drill closed-system drainage in 44, and craniotomies in 72. An additional 72 patients were simply observed. Reoperations were recorded in 5 patients—4 who had previously undergone twist-drill drainage and 1 who had previously undergone a bur hole procedure (p = 0.41, chi-square analysis). Thirty-five patients (16.7%) died in hospital, 130 were discharged to rehabilitation or a skilled care facility, and 44 returned home. The follow-up period extended to a maximum of 8.3 years (median 1.45 years). Six-month and 1-year mortality rates were 26.3% and 32%, respectively. In the multivariate analysis (step-wise logistic regression), the sole factor that predicted in-hospital death was neurological status on admission (OR 2.1, p = 0.02, for each step). Following discharge, the median survival in the remaining cohort was 4.4 years. In the Cox proportional hazards model, only age (hazard ratio [HR] 1.06/year, p = 0.02) and discharge to home (HR 0.24, p = 0.01) were related to survival, whereas the type of intervention, whether surgery was performed, size of subdural hematoma, amount of shift, bilateral subdural hematomas, and anticoagulant agent use did not affect the long- or short-term mortality rate. Comparison of postdischarge survival and anticipated actuarial survival demonstrated a markedly increased mortality rate in the CSDH group (median survival 4.4 vs 6 years, respectively; HR 1.94, p = 0.0002, log-rank test). This excess mortality rate was also observed at 6 months postdischarge with evidence of normalization only at 1 year. Conclusions In this first report of the long-term outcome of elderly patients with CSDH the authors observed persistent excess mortality up to 1 year beyond diagnosis. This belies the notion that CSDH is a benign disease and indicates it is a marker of other underlying chronic diseases similar to hip fracture.

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Modified Ilizarov technique for the treatment of forearm deformities in multiple cartilaginous exostoses: case series and literature review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412450651 ◽

2012 ◽

Vol 38 (3) ◽

pp. 288-296 ◽

Cited By ~ 11

Author(s):

S. H. Song ◽

H. Lee ◽

H. Youssef ◽

S. M. Oh ◽

J. H. Park ◽

...

Keyword(s):

Range Of Motion ◽

Functional Status ◽

Corrective Osteotomy ◽

Case Series ◽

Ilizarov Method ◽

Ilizarov Technique ◽

Before And After ◽

The Mean ◽

Multiple Cartilaginous Exostoses

The aim of this study is to evaluate the results of gradual ulnar correction and lengthening using the modified Ilizarov technique for the treatment of forearm deformities in patients with multiple cartilaginous exostoses. We retrospectively reviewed 23 forearms in 16 patients. Three different types of operative procedures were performed: (1) corrective osteotomy and gradual lengthening of the ulna, (2) corrective osteotomy of the radius, and (3) excision of exostoses. We evaluated the radiographs; range of motion of the wrist, forearm, and elbow; and functional status using a questionnaire before and after operation. During the clinical interview, post-operative functional status was significantly improved than pre-operative functional status, 12 patients stated that they had no difficulty in performing daily activities, 11 patients stated that they had no pain, and 11 patients stated that the post-operative appearance of the operated forearm was satisfactory. At time of final follow-up, the mean range of motion of the wrist in ulnar/radial deviation, forearm pronation/supination was significantly improved. Also, the radiographic parameters including radial articular angle, carpal slip, radial bowing, and ulnar variance were significantly improved at time of final follow-up. In conclusion, we achieved successful clinical and radiological outcomes in our patients with forearm deformities after treatment with the modified Ilizarov method. However, there could be a recurrence of ulnar shortening and deformity during growth periods in skeletally immature patients.

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Cardiac MRI in patients with complex CHD following primary or secondary implantation of MRI-conditional pacemaker system

Cardiology in the Young ◽

10.1017/s1047951115000190 ◽

2015 ◽

Vol 26 (2) ◽

pp. 306-314 ◽

Cited By ~ 4

Author(s):

Nadya Al-Wakeel ◽

Darach O h-Ici ◽

Katharina R. Schmitt ◽

Daniel R. Messroghli ◽

Eugénie Riesenkampff ◽

...

Keyword(s):

Clinical Study ◽

Adverse Effects ◽

Cardiac Mri ◽

Complete Conversion ◽

Secondary Implantation ◽

Before And After ◽

Grading Scale ◽

Clinical Questions ◽

Mri Conditional

AbstractObjectivesIn patients with CHD, cardiac MRI is often indicated for functional and anatomical assessment. With the recent introduction of MRI-conditional pacemaker systems, cardiac MRI has become accessible for patients with pacemakers. The present clinical study aims to evaluate safety, susceptibility artefacts, and image reading of cardiac MRI in patients with CHD and MRI-conditional pacemaker systems.Material and methodsCHD patients with MRI-conditional pacemaker systems and a clinical need for cardiac MRI were examined with a 1.5-T MRI system. Lead function was tested before and after MRI. Artefacts and image readings were evaluated using a four-point grading scale.ResultsA total of nine patients with CHD (mean age 34.0 years, range 19.5–53.6 years) received a total of 11 cardiac MRI examinations. Owing to clinical indications, seven patients had previously been converted from conventional to MRI-conditional pacemaker systems. All MRI examinations were completed without adverse effects. Device testing immediately after MRI and at follow-up showed no alteration of pacemaker device and lead function. Clinical questions could be addressed and answered in all patients.ConclusionCardiac MRI can be performed safely with high certainty of diagnosis in CHD patients with MRI-conditional pacemaker systems. In case of clinically indicated lead and box changing, CHD patients with non-MRI-conditional pacemaker systems should be considered for complete conversion to MRI-conditional systems.

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