Chronic Subdural Haematoma in Patients Over 90 Years: Outcome after Surgical Treatment

Research Article

Austin Neurosurg Open Access. 2014;1(5): 1022.

Chronic Subdural Haematoma in Patients Over 90 Years: Outcome after Surgical Treatment

Zoia C1*, Verlotta M2, Fratto A2, Cattalani A2, Turpini E2 and Gaetani P1

1Department of Neurosurgery, IRCCS Fondazione Policlinico San Matteo, Italy

2Neurosurgery - Department of clinical surgical diagnostic and pediatric science, University of Pavia, Italy

*Corresponding author: Cesare Zoia, Department of Neurosurgery, IRCCS Fondazione Policlinico San Matteo, Via Verdi 12, 21020 Casciago, Varese, Italy

Received: August 20, 2014; Accepted: September 12, 2014; Published: September 17, 2014


Purpose: This retrospective study evaluates outcomes in patients over 90 years of age who underwent surgery for cSDH.

Methods: A retrospective review of clinical and surgical records of patients operated at our center between 2008 and 2012 for chronic subdural haematoma was performed.

Results: Sixteen patients aged 90 years or older underwent surgery for cSDH at our center between 2008 and 2012; ten were man and six were woman. Two patients required a new surgery for recurrence of hematoma. Two patients died in the postoperative period, five patients were discharged home, seven went to rehabilitation and two come back to a nursing home.

Conclusion: This study shows that surgery in elderly patients can improve neurological status despite medical conditions.

Keywords: Chronic Subdural Haematoma; Elderly Patients; Neurosurgery


According to the latest figures from the Eurostat the Italian population of people aged 85 years or older is predicted to increase from 1.8 [1] to 5.6 [2] million by the year 2060, when the Italian population should total 65 million [2]. Given the incidence of Chronic Subdural Haematoma (cSDH), that has been reported as 127.1/100.000/year in patients over 80 years old [3], physicians will consequently be faced with an increasing number of very elderly patients presenting with this pathology. A lot of studies about cSDH in the elderly have been published [4-10,11,12] but the most of them consider as elderly people aged 65 or over. This retrospective study was therefore designed to evaluate the outcome after surgical treatment in aged over 90 years with cSDH and to investigate if there are any factors that can be used to contraindicate the surgical treatment.

Patients and Methods

Institutional review board approval for a retrospective study was obtained. Records of all patients who underwent surgery for cSDH in our institution from January 1, 2008, to December 31, 2012, were screened by age. Data regarding age at time of surgery, gender, therapies, medical co-morbidities and clinical presentation were extracted. Patient race was not recorded, although the majority of patients were known to be Caucasian.

Outcome was measured by Markwalder grading system (MGS) [13] and Glasgow outcome score (GOS) [14]. Survival times were calculated in months from the time of initial surgery until death or the end of follow-up in December 2013. The length of survival was compared with the expected length of survival for the Italian based on life tables obtained from the National Statistics Institution (ISTAT). Data were analyzed by the Kaplan Meier method with log rank significance tests.


From 2008 till 2012 sixteen patients aged 90 years or older underwent surgery at our institution for cSDH. The mean patient age was 92.1 years (range 90 - 101 years, SD 2,49). There were ten men and six women. Two patients were admitted from a nursing home, eleven from home and in three patients their residence was unknown.

At the time of admission, nine patients were under anticoagulant or antiaggregant because of cardiac pathologies or ictus cerebri. In these patients, the therapy was stopped until a CT evaluation in the follow-up; if no signs of rebleeding or recurrence were reported, therapy was restarted. Five patients (31.25%) had a history of head injury.

As showed in Table 1 the most common clinical presentation was hemiparesis (eight cases), followed by disorientation and disphasia/ aphasia (three cases).