The Danish Chronic Subdural Hematoma Study-Risk Factors for Second Recurrence

Area of Science:

• Neurosurgery
• Clinical Neurology
• Radiology

Background:

• Multiple recurrent chronic subdural hematomas (CSDH) present significant treatment challenges.
• Identifying specific risk factors for CSDH recurrence is crucial for personalized treatment, prognostication, and surgical strategy.
• This study aimed to identify pretreatment risk factors for a second CSDH recurrence (re-re-CSDH).

Purpose of the Study:

• To identify pretreatment risk factors for a second recurrence of chronic subdural hematoma (re-re-CSDH).
• To identify risk factors for developing re-re-CSDH after initial surgery for a first recurrence.

Main Methods:

• Retrospective analysis of clinical and demographic data from Danish neurosurgical patients (2010-2012).
• Data collected before evacuation of primary CSDH, first recurrent CSDH (re-CSDH), and re-re-CSDH.
• Comparison of patients undergoing first, second, and third CSDH evacuations to identify risk factors.

Main Results:

• The cohort included 1052 patients: 172 with re-CSDH and 29 with re-re-CSDH.
• Risk factors for re-re-CSDH included radiological subtype, midline shift, and hematoma volume.
• Postoperative drainage was associated with a lower risk of re-re-CSDH, but these factors were not specific.

Conclusions:

• Similar independent risk factors were found for re-CSDH and re-re-CSDH.
• It was not possible to identify specific pretreatment risk factors for patients at high risk of re-re-CSDH.
• Lack of specific risk factors hinders personalized treatment and prognostication for multiple CSDH recurrences.