Subdural evacuating port system with subdural thrombolysis for treatment of chronic subdural hematoma in patients over 80 years old

Introduction: 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 aimed to analyze the effectiveness of SEPS with subdural thrombolysis in patients aged ≥ 80 years.

Methods: Consecutive patients aged ≥80 years who presented with symptomatic CSDH and underwent SEPS followed by subdural thrombolysis between January 2014 and February 2021. Outcome measures included complications, mortality, recurrence, and modified Rankin Scale (mRS) scores at discharge and at 3 months. We performed a literature review of burr-hole drainage (BHD) in very elderly patients with CSDH.

Results: In 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%) were male. Preexisting medical comorbidities were observed in 39 (75.0%) patients. Postoperative complications occurred in 9 patients (17.3%), with 2 having significant complications (3.8%). 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 favorable outcomes (mRS score 0-3) were achieved in 86.5% and 92.3% of the patients, respectively. CSDH recurrence was observed in 5 patients (9.6%), and repeat SEPS was performed.

Conclusion : As 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 BHD.