Document Detail


Traumatic chronic subdural hematoma over 80 years. A preliminary prospective study.
MedLine Citation:
PMID:  9385567     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Six very elderly patients (mean of age: 85 years with range from 80 to 95 years) with mean GCS = 12 and mean clinical grade = 2.5 affected by traumatic chronic subdural hematoma (CT mean maximum thickness = 2.8 +/- 0.46 cm with midline shift = 1.56 +/- 0.48 cm and absence of homolateral mesencefalic cistern in all case but one) underwent parietal or frontal craniectomy under temporalis muscle and 48-h closed subdural drain. There was no mortality as consequence of the operative procedure. In all the patients but one who died postoperatively from a preoperative midbrain infarction secondary to a transtentorial herniation, there was a progressive and slow clinical improvement in spite of residual markedly persistent fluid collection (CT mean maximum thickness 1.44 +/- 0.19 cm) with mass effect (CT mean midline shift = 0.5 +/- 0.17 cm) due to a some failure of the brain to re-expand. Impairment of hemodynamic reserve should be considered as important cause of failure of the brain re-expansion. Clinical and CT control within two months after discharge from hospital demonstrated further clinical improvement (mean GOS = 4.6) and resolution of subdural residual fluid collection. Basing on these results we recommend do not reoperate persistent subdural fluid collection if there is clinical improvement. The patient can be discharged from hospital or transferred to Geriatric Department where he can be clinically and CT evaluated. Only a clinical deterioration or an increase of residual subdural fluid collection provides clear indication to reoperative surgery.
Authors:
A Zingale; V Albanese; A Romano; G Distefano; J Chiaramonte
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of neurosurgical sciences     Volume:  41     ISSN:  0390-5616     ISO Abbreviation:  J Neurosurg Sci     Publication Date:  1997 Jun 
Date Detail:
Created Date:  1998-01-14     Completed Date:  1998-01-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0432557     Medline TA:  J Neurosurg Sci     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  169-73     Citation Subset:  IM    
Affiliation:
Institute of Neurosurgery, University of Catania, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Hospital, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Chronic Disease
Female
Hematoma, Subdural / etiology*,  radiography
Humans
Male
Prospective Studies
Tomography, X-Ray Computed
Wounds and Injuries / complications*

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