Rescue Craniectomy With Subsequent Cranioplasty for Recurrent Symptomatic Subdural Hematoma in the Elderly

Abstract Introduction Recurrent subdural hematoma (SDH) is commonly encountered in clinical practice. Multiple surgical techniques have been reported for the management of recurrent SDH with variable success and complication rates. We report an alternative technique to halt SDH re-accumulation in elderly patients with multiple recurrences despite multiple surgical evacuations via rescue craniectomy and subsequent cranioplasty. Methods The authors retrospectively identified all symptomatic recurrent SDH in elderly patients (age ≥60 years) who were surgically managed with rescue craniectomy with subsequent cranioplasty from November 2004 to January 2018. Patients’ demographics and radiological and surgical variables were recorded and analyzed. Results Of the 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 our cohort was 73 years (IQR: 62-78), with 13 males and 6 females. Trauma was the culprit in the majority of cases. Five patients had acute SDH, 4 cases had subacute SDH, and 10 cases had chronic SDH. Fourteen cases had only one recurrence of SDH requiring surgical re-evacuation while 5 cases had two recurrences. The median interval between craniectomy and cranioplasty was 64.5 days (interquartile range: 108.3 days). Four complications were encountered. After cranioplasty, 15 cases had no further hemorrhage or recurrence and 4 cases had stable subdural collection during an average follow-up period 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.