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Rescue Craniectomy with Subsequent Cranioplasty for Recurrent Symptomatic Subdural Hematoma in Elderly Patients
- Source :
- World neurosurgery. 136
- Publication Year :
- 2019
-
Abstract
- Introduction Recurrent subdural hematoma (SDH) is commonly encountered in clinical practice. Multiple surgical techniques have been reported for the management of recurrent SDH with variable success and complication rates. We report an alternative technique to halt SDH re-accumulation in elderly patients with multiple recurrences despite multiple surgical evacuations via rescue craniectomy and subsequent cranioplasty. Methods The authors retrospectively identified all symptomatic recurrent SDH in elderly patients (age ≥60 years) who were surgically managed with rescue craniectomy with subsequent cranioplasty from November 2004 to January 2018. Patients’ demographics and radiological and surgical variables were recorded and analyzed. Results Of the 287 patients who received surgical treatment for SDH, 19 patients (6.6%) underwent SDH evacuation with rescue craniectomy and subsequent cranioplasty were included in the study. The median age of our cohort was 73 years (IQR: 62-78), with 13 males and 6 females. Trauma was the culprit in the majority of cases. Five patients had acute SDH, 4 cases had subacute SDH, and 10 cases had chronic SDH. Fourteen cases had only one recurrence of SDH requiring surgical re-evacuation while 5 cases had two recurrences. The median interval between craniectomy and cranioplasty was 64.5 days (interquartile range: 108.3 days). Four complications were encountered. After cranioplasty, 15 cases had no further hemorrhage or recurrence and 4 cases had stable subdural collection during an average follow-up period of 38.2±46.9 months. Conclusions Rescue craniectomy followed by cranioplasty is a safe and effective salvage technique for the management of symptomatic recurrent SDH in elderly patients.
- Subjects :
- Male
medicine.medical_specialty
Decompressive Craniectomy
medicine.medical_treatment
macromolecular substances
Culprit
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Hematoma
Postoperative Complications
Interquartile range
Recurrence
medicine
Humans
Surgical treatment
Aged
Retrospective Studies
business.industry
Skull
Middle Aged
Plastic Surgery Procedures
medicine.disease
Cranioplasty
Surgery
Hematoma, Subdural
Treatment Outcome
030220 oncology & carcinogenesis
Radiological weapon
Cohort
Female
Neurology (clinical)
Complication
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 136
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....336f9a2a40ffd9854e8821bd25032d79