Predictors for Recurrence of Chronic Subdural Hematoma
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Published on: August 30, 2020
Alexander Hammer1, Alexander Tregubow, Ghassan Kerry
1Paracelsus Medical University, Department of Neurosurgery, Nürnberg, Germany.
Insights
Aphasia and separated chronic subdural hematoma (cSDH) predict recurrence after surgery. Homogeneous isodense cSDH indicates a good prognosis, and surgical drainage implants are crucial for preventing cSDH recurrence.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (cSDH) is a common neurosurgical condition.
- Recurrence of cSDH after surgical evacuation can lead to significant morbidity.
- Identifying factors influencing cSDH recurrence is essential for optimizing patient outcomes.
Purpose of the Study:
- To investigate predictors of cSDH recurrence following surgical treatment.
- To analyze the impact of patient demographics, clinical presentation, and imaging findings on cSDH recurrence.
- To evaluate the role of surgical technique, specifically subdural drainage, in preventing cSDH recurrence.
Main Methods:
- Prospective analysis of 73 patients surgically treated for cSDH.
- Evaluation of patient age, gender, trauma history, and comorbidities.
- Assessment of neurological symptoms, preoperative imaging (including midline shift), and intraoperative findings.
- Correlation of these factors with cSDH recurrence rates and the use of drainage implants.
Main Results:
- Aphasia was significantly associated with increased cSDH recurrence (p=0.008).
- Separated cSDH manifestation on preoperative imaging predicted higher recurrence rates (p=0.048).
- Absence of a drainage implant correlated with increased recurrence (p=0.016), while homogeneous isodense cSDH showed no recurrence (p=0.037).
Conclusions:
- Aphasia and separated cSDH are significant predictors of recurrence.
- Homogeneous isodense cSDH is a favorable prognostic indicator for non-recurrence.
- Surgically applied drainage implants are vital in minimizing the risk of cSDH recurrence.
Aim:
This prospective study was designed to analyze the dependence of different factors on the recurrence rate of chronic subdural hematoma (cSDH) after surgical treatment.
Material And Methods:
Seventy-three consecutive patients, who were surgically treated at our department due to cSDH between 2009 and 2012, were included. The following parameters were analyzed: patient age and gender, occurrence of trauma, time between trauma and admission, neurological symptoms, presence of minor diseases, intake of anticoagulation medication. We classified the results of diagnostic imaging and determined the space-consuming effect via the cerebral midline shift. In addition, we scrutinized intraoperative findings and the dependence of the position of subdural drainage on the recurrence rate of cSDH.
Results:
In our patient group, cSDH recurrence was significantly associated with aphasia (p=0.008). Moreover an increased cSDH recurrence rate was observed in the patient group that had a separated manifestation of the cSDH in the preoperative diagnostic imaging (p=0.048) and received no drainage implant (p=0.016). Homogeneous isodense cSDH was associated with no apparent recurrence (p=0.037).
Conclusion:
Within the scope of this study, we detected aphasia and separated cSDH as predictors of cSDH recurrence. Homogeneous isodense cSDH seems to be a good prognostic sign regarding the risk of recurrence development. Furthermore, our data clearly emphasize the importance of surgically applied drainage implants to prevent a recurrence of cSDH.
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