Chronic subdural hematoma: clinical and surgical experience with surgical management in a large cohort of patients in the late and frailest phase of life

OBJECTIVE To date, there is no consensus on treatment indications for chronic subdural hematoma (CSDH) in patients in their 10th decade of life. The present investigation aims to focus on and carefully evaluate the clinical course of this particularly fragile subgroup of patients. METHODS The authors retrospectively analyzed the clinical, radiological, and surgical records from a multicentric prospectively maintained database of patients with CSDH surgically treated between June 2005 and August 2021. Patients included in the study were divided into two subgroups: group A, those whose age was < 90 years; and group B, those whose age was ≥ 90 years. The following variables were recorded for each patient: age, sex, clinical disease onset, history of traumatic brain injury, antiplatelet or anticoagulant use, and pre- and/or postoperative corticosteroid medication intake. The surgical approach and whether a surgical drain had been left in the subdural space were recorded, as was the anesthesia protocol. Clinical results were measured using the Markwalder Grading Scale. Recurrence and mortality were analyzed separately. RESULTS The final cohort comprised 1312 patients who had undergone surgery for CSDH, 1240 patients whose age was < 90 years and 72 patients whose age was ≥ 90. Patients in their 10th decade of life experienced similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation in Markwalder grades was favorable in elderly patients (p = 0.006). Multivariate analyses confirmed that local anesthesia (p = 0.013), single-sided CSDH (p = 0.010), and no antiplatelet or anticoagulant intake (p = 0.004 and p = 0.037, respectively) are independent predictors of favorable outcomes. CONCLUSIONS Patients in their 10th decade can experience clinical and radiological outcomes similar to those in their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.