title: Chronic subdural hematoma in patients over 90 years old in a super-aged society.
abstract: BACKGROUND
  Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgical practice, particularly among aged patients. With the continuing increase in the aged population, further increases in incidence are expected. However, few studies have focused on CSDH in super-aged patients over 90 years old.
  
  
  METHODS
  We retrospectively reviewed medical records for 20 consecutive patients over 90 years old with CSDH treated in our department between 2007 and 2013. The diagnosis of CSDH was confirmed by computed tomography (CT). Patients were divided into a surgery group and a conservative group. Surgical procedures included burr-hole surgery followed by insertion of a subdural drain under local anesthesia. Clinical data were compared and analyzed. Neurological status was evaluated according to the modified Rankin Scale at three time points: before suffering from CSDH; at the time of referral or admission to our department; and at discharge or 1 month after the first referral. Statistical tests were used to analyze data and values of P < 0.05 were considered significant.
  
  
  RESULTS
  Mean age for the 20 cases was 92.6 years (range, 90 - 96 years). The leading symptoms in this population were hemiparesis and gait disturbance, followed by disturbance of consciousness and speech disturbance. Twelve patients underwent burr-hole surgery. Mean maximum thickness of subdural hematoma as measured on CT was significantly higher in the surgery group (28.2 ± 5.4 mm) than in the conservative group (17.0 ± 3.8 mm; P < 0.01). Postoperatively, mean neurological status was significantly improved in the surgery group (P < 0.01). After surgery, 66.7% of patients could return home directly from hospital. No significant perioperative complications directly related to surgery were encountered in the surgery group, except for transient postoperative restlessness and bruising of extremities due to falls.
  
  
  CONCLUSIONS
  Surgery for CSDH is safe and positively recommended even in super-aged patients over 90 years old if the patient's physical status is fair. Pre-illness status is the most important factor for considering operative indications and represents a limiting factor for postoperative outcomes in this age population.
authors.affiliation: Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan.
authors.forename: Sadaharu
authors.initials: S
authors.lastname: Tabuchi
authors.affiliation: Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Kadowaki
keywords: 90 years old; Aged; Chronic subdural hematoma; Elderly; Surgical treatment
references.citation: Neurol Med Chir (Tokyo). 2001 Aug;41(8):371-81
references.pmid: 11561347
references.citation: Neurosurg Rev. 2004 Oct;27(4):263-6
references.pmid: 15148652
references.citation: Biol Pharm Bull. 2011;34(5):688-92
references.pmid: 21532158
references.citation: J Neurol Neurosurg Psychiatry. 2003 Jul;74(7):937-43
references.pmid: 12810784
references.citation: No Shinkei Geka. 2011 Dec;39(12):1149-53
references.pmid: 22128269
references.citation: J Neurosci Rural Pract. 2013 Jul;4(3):250-6
references.pmid: 24250154
references.citation: No To Shinkei. 1993 May;45(5):449-53
references.pmid: 8343296
references.citation: Acta Neurochir (Wien). 2012 Sep;154(9):1549-54
references.pmid: 22772400
references.citation: J Neurosurg. 2011 Jan;114(1):72-6
references.pmid: 20868215
references.citation: Clin Neurol Neurosurg. 2013 Jul;115(7):981-4
references.pmid: 23128014
references.citation: PLoS One. 2013 Jul 12;8(7):e68732
references.pmid: 23874740
references.citation: Neurol Res. 2013 Apr;35(3):243-6
references.pmid: 23485051