title: [Chronic subdural haematomas in very elderly patients].
abstract: BACKGROUND
  Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years.
  
  
  METHODS
  A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma.
  
  
  RESULTS
  A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001).
  
  
  CONCLUSIONS
  CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality.
authors.affiliation: Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Castro-Rodríguez
authors.affiliation: Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España; Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
authors.forename: Paula
authors.initials: P
authors.lastname: Román-Pena
authors.affiliation: Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España; Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arán-Echabe
authors.affiliation: Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, España; Servicio de Neurocirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España. Electronic address: miguel.gelabert@usc.es.
authors.forename: Miguel
authors.initials: M
authors.lastname: Gelabert-González
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant/anti-platelet therapy; Chronic subdural haematoma; Grados de Markwalder; Hematoma subdural crónico; Markwalder grade; Muy anciano; Surgical treatment; Tratamiento antiagregante y anticoagulante; Tratamiento quirúrgico; Very elderly patients