The Comparison Of Surgical And Conservative Management Of Chronic Subdural Hematoma In Elderly Patients

Background and ObjectiveChronic subdural hematoma (cSDH) is a common disease, which accounts for approximately about10%of all intracranial hematoma. cSDH led to intracranial hypertension, such as headache, vomiting, and papilledema. The characteristic performance that crescent-shaped or half-moon shadows with mixed or equal density on computed tomography (CT) was usually used to diagnose cSDH. In some cases, large hematoma can cause midline shift and ventricular compression, which is helpful to diagnose cSDH. Up to now, the surgical management was regarded as the preferred treatment, especially burr-hole drainage with less trauma and better prognosis. However, elderly patients always suffered chronic diseases, such as diabetes, hypertension, coronary artery disease, so that those elderly patients were unable to tolerate surgery. The present study aims to explore the therapeutic schedule with maximum effectiveness and safety for elderly patients with cSDH.Material and MethodsIn this prospective study, we enrolled elderly patients aged60-100years with cSDH, who were diagnosed by the Yiwu Central Hospital of Zhejiang Province. The patients were randomly allocated to single-hole single-tube group (SHST), single-hole double-tube group (SHDT) and conservative treatment group. The outcomes were operative time, blood loss, hospital stay, outcomes, pneumocephalus, residual liquid volume, the recurrence rate and other indicators.ResultsFrom June1,2012, to May31,2014,61patients were randomly assigned to SHST (n=20), SHDT (n=20), and conservative treatment group (n=21). No significant difference existed in age, sex ratio, underlying diseases, hematoma location, the size of hematoma, CT performance (P>0.05) among three groups. Surgical groups showed a significant decrease in hospitalization time with higher cute rate and lower recurrence rate (P<0.05) compared to conservative treatment group. SHDT group had a significant decrease in pneumocephalus and residual liquid volume (P<0.05), while no significant difference in the hospitalization time, operative time, and blood loss (P>0.05) compared with SHST. The rate of lost of follow-up were2/20patients in SHST group,1/20patient in SHDT group, and4/21patients in conservative treatment group.ConclusionsThe preferred treatment option for elderly patients with cSDH was SHST, which had a high cure rate with a significantly decrease in postoperative pneumocephalus, residual liquid volume, subdural effusion, and the recurrence of subdural hematoma.