Clinical analysis of the elderly patients with chronic subdural hematoma treated by trepanation and drainage under multi-disciplinary team

Abstract

Objective To explore the multi-disciplinary diagnosis and treatment mode of elderly patients with chronic subdural hematoma (CSDH), and the effect and safety of trepanation and drainage under this mode. Methods A total of 37 elderly patients with CSDH (≥ 80 years old) were treated by trepanation and drainage under multi-disciplinary team (MDT) model from December 2014 to December 2018. Summarized the perioperative management process of CSDH in the elderly patients under MDT model, and observed its complications and prognosis. Bender grade was used to evaluate the clinical symptoms and neurological deficits, CT was used to evaluate the curative effect, and Karnofsky Performance Status (KPS) was used to evaluate quality of life. Results Operation-related complications of 37 patients included non-tension pneumocephalus (19 cases, 51.35% ), subdural effusion in (5 cases, 13.51% ),intracranial hypotension (2 cases, 5.41% ) and epilepsy (1 case, 2.70% ). The age-related complications included new pulmonary infection (1 case, 2.70% ), abnormal blood pressure (3 cases, 8.11% ), elevated blood sugar (2 cases, 5.41%) and acute coronary diseases (3 cases, 8.11%). There was no perioperative death. The clinical symptoms and neurological function was improved significantly after operation (Z = 6.198, P = 0.000). Postoperative CT showed that the total effective rate was 86.49% (32/37). During the follow-up period, the KPS was over 60 score, and CT showed that the total effective rate was 96.43% (27/ 28). Conclusions MDT model can optimize the diagnosis and treatment process of CSDH, and formulate detailed individualized treatment plan. Trepanation and drainage under the MDT model for the treatment of elderly patients with CSDH is helpful to improve prognosis and reduce mortality.

DOI:10.3969/j.issn.1672-6731.2019.09.011