Por Jamil Farhat Neto, João Luiz Vitorino Araujo, Vinícius Ricieri Ferraz, Luciano Haddad e José Carlos Esteves Veiga
Disciplina de Neurocirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brasil.
ABSTRACT
Objective: To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators.
Methods: We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment.
Results: The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients.
Conclusion: the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.
Key words: Hematoma, Subdural, Chronic; Intracranial Hemorrhages; Neurosurgery; Epidemiology; Prognosis
