• Shinya Watanabe, Noriyuki Kato, Masayuki Sato, Hitoshi Aiyama, Yusuke Fujiwara, Masayuki Goto, Tomosato Yamazaki, Susumu Yasuda, Eiichi Ishikawa, and Akira Matsumura.
• Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan; Department of Neurosurgery, Mito Medical Center, Ibaraki-machi, Japan.
• World Neurosurg. 2019 Dec 1; 132: e812-e819.

BackgroundFew reports have focused on chronic subdural hematoma (CSDH) in the very elderly, who have lived beyond average life expectancy. Our aim is to appraise treatment outcomes of burr-hole craniotomy for CSDH in the elderly, focusing on cure, recurrence, and complications.MethodsFifty patients ≤79 years of age (group A) and 73 patients ≥80 years of age (group B) were studied. Recurrence was defined as requiring reoperation for hematoma regrowth or symptomatic failure. A cure was regarded as having been achieved in the absence of hematoma on postoperative computed tomography. Complications were defined as any harmful event related to the treatment procedure for CSDH.ResultsCure was documented in 31 patients in group A (63%) and 24 patients in group B (33%) (P = 0.0017). Median intervals to cure were 2.76 and 3.73 months, respectively (P = 0.06). Cumulative cure rates were 51%/76% and 36%/59%, respectively, at the sixth/twelfth postoperative months. Recurrence was documented in 2 patients (4%) and 11 patients (15%), respectively (P = 0.07). Median intervals to recurrence were 0.81 and 1.25 months, respectively (P = 0.049). Cumulative recurrence-free rates were 96%/92% and 87%/75%, respectively, at the third/sixth postoperative months. Complications were observed in 2 patients (4%) and 4 patients (5%), respectively (P = 1.00).ConclusionsWith advancing age, CSDH might show a greater tendency to recur and a longer time is required to achieve a cure. However, complications developed only in high-risk patients. Thus, surgical treatment for CSDH in elderly patients, even those who have lived beyond life expectancy, might provide acceptably effective results.Copyright © 2019 Elsevier Inc. All rights reserved.

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