Related Experiment Video
Updated: Jul 13, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Risk factors for recurrence of chronic subdural hematoma after surgical evacuation: a systematic review and
Seyed Farzad Maroufi1,2, Farzin Farahbakhsh2,3, Robert Loch Macdonald4
1Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Insights
Recurrence after chronic subdural hematoma (CSDH) surgery is 12%. This study identified 31 risk factors, including preoperative, radiologic, and operative details, to improve patient selection for surgical evacuation.
Area of Science:
- Neurosurgery
- Epidemiology
Background:
- Chronic subdural hematoma (CSH) is a frequent neurosurgical diagnosis.
- Surgical evacuation is the standard treatment, but recurrence rates remain significant.
Approach:
- A comprehensive literature review and meta-analysis were performed.
- Data from 198 studies, including 8,523 recurrent and 56,096 non-recurrent CSH cases, were analyzed.
- Sixty potential risk factors were evaluated to identify those associated with recurrence.
Key Points:
- The overall recurrence rate after surgical evacuation for CSH was 12%.
- Fifteen preoperative, nine radiologic, four hematoma-related, and three operative/postoperative factors were significantly associated with recurrence.
- Identified risk factors can aid in pre-operative risk assessment and patient selection for surgery.
Conclusions:
- Understanding recurrence risk factors is crucial for neurosurgical decision-making.
- This research provides a basis for optimizing treatment planning and improving outcomes for CSH patients.
Abstract:
Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Surgical evacuation has remained the primary treatment despite many advancements in the endovascular field. Regardless, recurrence requiring reoperation is commonly observed during the postoperative follow-up. Herein, we aimed to investigate risk factors for recurrence after surgical evacuation. A review of MEDLINE, EMBASE, Web of Science, and Scopus was conducted using the designed search string. Studies were reviewed based on the predefined eligibility criteria. Data regarding sixty potential risk factors along with operational information were extracted for analysis. A meta-analysis using the random-effect model was conducted, and each risk factor affecting the postoperative recurrence of CSDH was then evaluated and graded. A total of 198 records met the eligibility criteria. A total number of 8523 patients with recurrent CSDH and 56,096 with non-recurrent CSDH were included in the study. The recurrence rate after surgical evacuation was 12%. Fifteen preoperative, nine radiologic, four hematoma-related, and three operative and postoperative factors were associated with recurrence. Risk factors associated with recurrence after surgical evacuation are important in neurosurgical decision-making and treatment planning. Found risk factors in this study may be used as the basis for pre-operative risk assessment to choose patients who would benefit the most from surgical evacuation.
