Acute Subdural Hematoma: Evaluation of Predictive Factors and Efficacy of Various Surgical Approaches on Prognosis.

AIM: To examine the parameters influencing prognosis, and the effectiveness of surgical techniques in patients aged over 65 years with acute subdural hematoma (ASH).

MATERIAL AND

METHODS

From 2017 to 2023, a retrospective evaluation was conducted on 62 individuals admitted to the emergency department, diagnosed with ASH, and who underwent had surgical interventions. Demographic data, Glasgow Coma Scale (GCS) score upon admission, radiological findings including hematoma volume, midline shift, and surgical techniques used (craniotomy, craniectomy), were examined. The impact of each predictive factor on prognosis was investigated.

RESULTS

The average patient age was 73.67 ± 10.00 years (range: 65 to 101 years). The mean GCS score at presentation was 9.00 ± 4.44. The average subdural hematoma volume was 62.2 ± 36.5 mL, and the average midline shift was 9.4 ± 7.7 mm. A significant positive correlation existed between the admission GCS score and the Glasgow Outcome Scale (GOS) score (? = 0.684, p < 0.001). Surgeries comprised 83.3% craniotomy, 11.9% craniectomy, and 4.8% extended craniectomy. The overall mortality rate was 19%. The rate of favorable clinical outcomes (GOS 4?5) was 31% in the craniotomy cohort and 18% in the craniectomy cohort (p=0.042).

CONCLUSION

Age, GCS score at presentation, hematoma volume, and midline displacement were significant factors influencing the prognosis in geriatric ASH patients. Patients who underwent craniotomy exhibited superior functional outcomes to those who underwent craniectomy (p=0.042). Surgeries conducted within an average of 3.4 ± 0.6 hours, along with treatment strategies tailored to individual clinical evaluations, appeared to enhance the prognosis.