Can recurrence of chronic subdural hematoma be predicted? A retrospective analysis of 292 cases

Chronic subdural hematomas are the most common type of intracranial hemorrhage among the elderly. There is a substantial recurrence rate after evacuation by burr-hole surgery. In this study, we aimed to determine the predictors of recurrence after single burr-hole evacuation of chronic subdural hematomas.

We retrospectively analyzed 292 consecutive patients with chronic subdural hematoma. Clinical parameters, anamnesis, and previous anticoagulant drug use have been evaluated with univariate and multivariate analyses to determine predictors associated with recurrence.

At least a second surgery was needed in 43 of 292 (14.7%) patients. We showed that recurrence rate was significantly higher in patients with bilateral subdural hematoma, after univariate and multivariate analyses (23.1% versus 11.4%). We did not find any significant relationship between recurrence rate and age, gender, hypertension, and/or diabetes mellitus in anamnesis, preceding head trauma, and time interval between trauma and the operation, previous anticoagulant, and/or antiaggregant therapy.

After analysis of all evaluated factors, only bilateral hematoma was found correlated with high recurrence rate (p = 0.01), probably due to previous brain atrophy or existing coagulopathy.