Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years
ObjectiveThe subdural evacuating port system (SEPS) is a minimally invasive approach that can be performed under local anesthesia for the treatment of chronic subdural hematoma (CSDH). Subdural thrombolysis has been described as an exhaustive drainage strategy and found to be safe and effective for...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1068829/full |
| _version_ | 1797924629596078080 |
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| author | Tianqing Liu Zhenwen Gao Jianjun Zhou Xiaoyan Lai Xiaomei Chen Qiong Rao Dongbin Guo Jinliang Zheng Fuxin Lin Yuanxiang Lin Zhiqin Lin Zhiqin Lin |
| author_facet | Tianqing Liu Zhenwen Gao Jianjun Zhou Xiaoyan Lai Xiaomei Chen Qiong Rao Dongbin Guo Jinliang Zheng Fuxin Lin Yuanxiang Lin Zhiqin Lin Zhiqin Lin |
| author_sort | Tianqing Liu |
| collection | DOAJ |
| description | ObjectiveThe subdural evacuating port system (SEPS) is a minimally invasive approach that can be performed under local anesthesia for the treatment of chronic subdural hematoma (CSDH). Subdural thrombolysis has been described as an exhaustive drainage strategy and found to be safe and effective for improving drainage. We aim to analyze the effectiveness of SEPS with subdural thrombolysis in patients older than 80 years.MethodConsecutive patients aged ≥80 years old who presented with symptomatic CSDH and underwent SEPS followed by subdural thrombolysis between January 2014 and February 2021 were retrospectively studied. Outcome measures included complications, mortality, recurrence, and modified Rankin Scale (mRS) scores at discharge and 3 months.ResultsIn total, 52 patients with CSDH in 57 hemispheres were operated on, with a mean age of 83.9 ± 3.3 years, and 40 (76.9%) patients were men. The preexisting medical comorbidities were observed in 39 patients (75.0%). Postoperative complications occurred in nine patients (17.3%), with two having significant complications (3.8%). The complications observed included pneumonia (11.5%), acute epidural hematoma (3.8%), and ischemic stroke (3.8%). One patient experienced contralateral malignant middle cerebral artery infarction and died of subsequent severe herniation, contributing to a perioperative mortality rate of 1.9%. Discharge and 3 months of favorable outcomes (mRS score 0–3) were achieved in 86.5% and 92.3% of patients, respectively. CSDH recurrence was observed in five patients (9.6%), and repeat SEPS was performed.ConclusionAs an exhaustive drainage strategy, SEPS followed by thrombolysis is safe and effective with excellent outcomes among elderly patients. It is a technically easy and less invasive procedure with similar complications, mortality, and recurrence rates compared with burr-hole drainage in the literature. |
| first_indexed | 2024-04-10T15:03:55Z |
| format | Article |
| id | doaj.art-280759803eb84266902025da6e8cd340 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-10T15:03:55Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-280759803eb84266902025da6e8cd3402023-02-15T06:52:03ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-02-011410.3389/fneur.2023.10688291068829Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 yearsTianqing Liu0Zhenwen Gao1Jianjun Zhou2Xiaoyan Lai3Xiaomei Chen4Qiong Rao5Dongbin Guo6Jinliang Zheng7Fuxin Lin8Yuanxiang Lin9Zhiqin Lin10Zhiqin Lin11Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaDepartment of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, ChinaDepartment of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, ChinaObjectiveThe subdural evacuating port system (SEPS) is a minimally invasive approach that can be performed under local anesthesia for the treatment of chronic subdural hematoma (CSDH). Subdural thrombolysis has been described as an exhaustive drainage strategy and found to be safe and effective for improving drainage. We aim to analyze the effectiveness of SEPS with subdural thrombolysis in patients older than 80 years.MethodConsecutive patients aged ≥80 years old who presented with symptomatic CSDH and underwent SEPS followed by subdural thrombolysis between January 2014 and February 2021 were retrospectively studied. Outcome measures included complications, mortality, recurrence, and modified Rankin Scale (mRS) scores at discharge and 3 months.ResultsIn total, 52 patients with CSDH in 57 hemispheres were operated on, with a mean age of 83.9 ± 3.3 years, and 40 (76.9%) patients were men. The preexisting medical comorbidities were observed in 39 patients (75.0%). Postoperative complications occurred in nine patients (17.3%), with two having significant complications (3.8%). The complications observed included pneumonia (11.5%), acute epidural hematoma (3.8%), and ischemic stroke (3.8%). One patient experienced contralateral malignant middle cerebral artery infarction and died of subsequent severe herniation, contributing to a perioperative mortality rate of 1.9%. Discharge and 3 months of favorable outcomes (mRS score 0–3) were achieved in 86.5% and 92.3% of patients, respectively. CSDH recurrence was observed in five patients (9.6%), and repeat SEPS was performed.ConclusionAs an exhaustive drainage strategy, SEPS followed by thrombolysis is safe and effective with excellent outcomes among elderly patients. It is a technically easy and less invasive procedure with similar complications, mortality, and recurrence rates compared with burr-hole drainage in the literature.https://www.frontiersin.org/articles/10.3389/fneur.2023.1068829/fullchronic subdural hematomasurgical treatmentsubdural evacuating port systemcomplicationoutcomerecurrence |
| spellingShingle | Tianqing Liu Zhenwen Gao Jianjun Zhou Xiaoyan Lai Xiaomei Chen Qiong Rao Dongbin Guo Jinliang Zheng Fuxin Lin Yuanxiang Lin Zhiqin Lin Zhiqin Lin Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years Frontiers in Neurology chronic subdural hematoma surgical treatment subdural evacuating port system complication outcome recurrence |
| title | Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years |
| title_full | Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years |
| title_fullStr | Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years |
| title_full_unstemmed | Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years |
| title_short | Subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years |
| title_sort | subdural evacuating port system with subdural thrombolysis for the treatment of chronic subdural hematoma in patients older than 80 years |
| topic | chronic subdural hematoma surgical treatment subdural evacuating port system complication outcome recurrence |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1068829/full |
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