Rescue Craniectomy with Subsequent Cranioplasty for Recurrent Symptomatic Subdural Hematoma in Elderly Patients

Objective: Recurrent subdural hematoma (SDH) is commonly encountered in clinical practice. Multiple surgical techniques have been reported for management of recurrent SDH with variable success and complication rates. We report an alternative technique to halt SDH reaccumulation in elderly patients with multiple recurrences despite multiple surgical evacuations via rescue craniectomy and subsequent cranioplasty.

Methods: We retrospectively identified all symptomatic recurrent SDHs in elderly patients (≥60 years old) who were surgically managed with rescue craniectomy with subsequent cranioplasty from November 2004 to January 2018. Patients' demographics and radiologic and surgical variables were recorded and analyzed.

Results: Of 287 patients who received surgical treatment for SDH, 19 patients (6.6%) underwent SDH evacuation with rescue craniectomy and subsequent cranioplasty were included in the study. The median age of the cohort was 73 years (interquartile range: 62-78 years), with 13 men and 6 women. Trauma was the cause of SDH in most cases. Five patients had acute SDH, 4 patients had subacute SDH, and 10 patients had chronic SDH. Fourteen patients had only 1 recurrence of SDH requiring surgical re-evacuation, and 5 had 2 recurrences. Median interval between craniectomy and cranioplasty was 64.5 days (interquartile range: 15-123.3 days). Four complications were encountered. After cranioplasty, 15 patients had no further hemorrhage or recurrence and 4 patients had stable subdural collection during an average follow-up of 38.2 ± 46.9 months.

Conclusions: Rescue craniectomy followed by cranioplasty is a safe and effective salvage technique for the management of symptomatic recurrent SDH in elderly patients.