Neurosurgical Resident Neurosurgical Department, University Hospital Heidelberg Heidelberg, Germany
Introduction: Chronic subdural hematomas, while being a common diagnosis in the elderly, are a rare pathology in patients younger than 50 years old. We, therefore, aimed to describe possible underlying factors that resulted in the cSDH of patients aged ≤ 50 years and analyzed their outcome.
Methods: All patients with a surgically treated chronic subdural hematoma presenting to a neurosurgical maximum care provider in Germany between 2006 and 2017 were retrospectively assessed and only adult patients aged ≤ 50 years were included for further analysis. Demographic and clinical variables were collected and outcomes at discharge as well as the rate of recurrence within 90 days were analyzed.
Results: Over a period of 11 years, 44 younger cSDH patients (mean age 42±10 years, 69% (n=30) male) could be identified, which represented 5% of all surgically treated cSDH patients during this period. Their most common comorbidity was a neoplastic disease (n=8; 18%). Only 21 patients (48%) reported a trauma 33±32 days prior to the cSDH diagnosis whereas cSDH occurred spontaneously in the remaining cases (52%; n=24). Most patients suffered from headaches as the only symptom of complaint (n=30, 68%). Evacuation of the cSDH was performed via burr hole trepanation in 91% (n=40) and via craniotomy in only 9% (n=4). Surgical and medical complications were 16% and 18%, respectively. After a mean hospital stay of 7,8±8,5 days, 86% (n=38) of patients were discharged with a Glasgow coma scale (GCS) of 15 and 77% (n=34) had clinically benefited from surgery.
Conclusion : Surgically treated chronic subdural hematomas are a rare pathology in patients under the age of 50 years and represent only 5% of the overall cSDH population. Of note, the rate of neoplastic diseases in the younger cSDH patients is relatively high and further analysis into the pathophysiology (e.g. paracrine VEGF expression) of this co-occurrence might be warranted.
