Chronic Subdural Hematoma in a Vast Cohort of Patients in their Ninth Decade of Life: is it a hostile and recursive disease? Italian CSDH Research Group

Abstract Objective To date, there is no consensus over treatment indications in ultra-elderly patients, in their ninth decade of life suffering from Chronic subdural hematoma (CSDH). The present investigation aims to focus and carefully report on the clinical course of such a particularly fragile subgroup of patients. Methods We retrospectively analyzed the clinical, radiological, and surgical records of a multicentric cohort of 1312 patients suffering from CSDH. We assigned the enrolled patients to two subgroups, Group A, whose age was under 90 years, and Group B, whose age was over 90 years. For each patient, we recorded age, sex, clinical onset, history of traumatic brain injury, antiplatelet/anticoagulant, and pre and postoperative corticosteroid medication intake. We recorded the surgical approach if a surgical drain was left in the subdural space and the anesthesia protocol. Clinical results were measured with the Markwalder score. Recurrence and mortality were analyzed either. Results The final cohort comprised 1312 patients operated on for CSDH. Patients in their ninth decade of life may experience, similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation of the Markwalder scores appears to be favorable in elderly patients. Multivariate analyses confirm that preoperative corticosteroids, local anesthesia, single-side CSDH, and no antiplatelet/anticoagulant intake are further independent predictors of favorable outcomes. Conclusions Patients in their ninth-decade experience similar clinical and radiological outcomes compared to their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.