Chronic subdural hematomas and the elderly: Surgical results from a series of 125 cases: Old "horses" are not to be shot!
BACKGROUND
To present the accumulated experience from treating chronic subdural hematomas (CSDH) in a local hospital of a third world country.


METHODS
One hundred and twenty-five consecutive patients with CSDH who were surgically treated in the Neurosurgical Department of the Hospital da Restauração, Recife-PE, Brazil, between January 2006 and May 2008, were retrospectively studied. Glasgow Outcome Scale (GOS) was employed to define outcome at 6 months as good (GOS 4 and 5) or poor (GOS ≤ 3). Age, admission Glasgow Coma Scale (GCS), location of hematomas (unilateral/bilateral), drainage system placement and recurrence were all analyzed for potential impact on final outcome.


RESULTS
The median age was 69 years, with a male/female ratio of 102/23. History of trauma was present in 60.8% of the patients. The median GCS on admission was 14. In 64 patients, the hematoma was on the left side, while in 42 patients it was on the right side. Bilateral hematomas were present in 19 cases (15.2%). Drainage systems were used in 93.6% of the cases. Recurrence occurred in 8.8% of the patients. One hundred and three patients obtained a good outcome at 6 months. The mortality rate was 11.2%. Patients with GCS ≥9 on admission presented better outcome (P < 0.05). Recurrent cases presented a poor outcome (P < 0.05).


CONCLUSIONS
This study suggests that the main factors associated with outcome in patients harboring CSDH are the admission GCS score and the recurrence status. Advanced age is not a contraindication for surgical treatment. This study, solely focused on the Brazilian population, is the first of its kind in the English literature, and it could serve as a useful introduction to a more complex, multivariate, debate.
Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil.
Danilo Otávio
DO
de Araújo Silva
Georgios K
GK
Matis
Leonardo Ferraz
LF
Costa
Matheus Augusto Pinto
MA
Kitamura
Eduardo Vieira
EV
de Carvalho Junior
Monalisa
M
de Moura Silva
Breno José A P
BJ
Barbosa
Carlos Umberto
CU
Pereira
Joacil Carlos
JC
da Silva
Theodossios A
TA
Birbilis
Hildo Rocha Cirne
HR
de Azevedo Filho
Chronic subdural hematoma; outcome; recurrence; surgical treatment