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Factors for predicting recurrence after burr hole drainage for chronic subdural hematoma: a retrospective study
Gi Jeong Jeon1, Hyun Taek Rim1, Heui Seung Lee1
1Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170Beon-Gil, Dongan-Gu, Anyang-Si, Gyeonggi-Do, 14068, Republic of Korea.
Insights
Male sex, bilateral hematomas, laminar hematoma type, large postoperative residual hematoma volume, and high preoperative blood glucose levels are key predictors of chronic subdural hematoma recurrence after surgery. Close post-operative monitoring is recommended.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (SDH) is a common neurosurgical condition.
- Burr hole trephination is the standard surgical treatment for SDH.
- Predicting SDH recurrence after surgery remains challenging due to inconsistent study results.
Purpose of the Study:
- To identify independent predictive factors for chronic SDH recurrence in surgically treated patients.
- To provide a comprehensive analysis of clinical and radiological predictors.
- To improve patient management strategies for SDH.
Main Methods:
- Retrospective analysis of 578 patients undergoing single burr hole surgery for chronic SDH (2008-2021).
- Comparison of clinical and radiological factors between patients with and without recurrence.
- Univariate and multivariate logistic regression analyses were employed.
Main Results:
- Recurrence occurred in 10.17% of 531 hemispheres within 6 months.
- Independent predictors of recurrence included male sex, bilateral hematomas, laminar hematoma type, >30 cm³ postoperative residual hematoma, and preoperative blood glucose ≥150 mg/dL.
- Significant adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported for each factor.
Conclusions:
- Male sex, bilateral SDH, laminar type, large residual hematoma, and high preoperative glucose predict recurrence.
- These findings aid in identifying high-risk patients for closer post-operative surveillance.
- Targeted monitoring can help detect and manage recurrent chronic SDH effectively.
Abstract:
Chronic subdural hematoma (SDH) is a common disease in the neurosurgical field, and hematoma drainage through burr hole trephination has been widely considered the optimal treatment for SDH. Despite numerous investigations aimed at predicting recurrence rates and associated factors, studies have demonstrated inconsistent results. In this study, we aimed to comprehensively determine the predictive factors of chronic SDH recurrence in surgically treated patients. We retrospectively evaluated 578 consecutive patients who underwent single burr hole surgery for chronic SDH at our institute between January 2008 and December 2021. Various clinical and radiological factors in patients with and without recurrence were compared using univariate and multivariate logistic regression analyses. A total of 438 patients (531 hemispheres) were analyzed. Fifty-four (10.17%) of the 531 hemispheres had recurrence of chronic SDH within 6 months. Male sex (adjusted odds ratio (aOR) = 3.48; 95% confidence interval (CI), 1.42-8.49), bilateral hematomas (aOR = 2.14; 95% CI, 1.05-4.35), laminar hematoma type (aOR = 2.87; 95% CI, 1.23-6.71), > 30-cm3 volume of postoperative residual hematoma (aOR = 2.99; 95% CI, 1.01-8.83), and preoperative blood glucose level of ≥ 150 mg/dL (aOR = 2.11; 95% CI, 1.10-4.05) were identified as independent factors associated with recurrence in multivariate logistic regression analysis. The present study revealed that male patients and those who had bilateral hematomas, laminar hematoma type, a large volume of hematoma after surgery, and a high preoperative blood glucose level had a higher probability of experiencing recurrent chronic SDH. We recommend close monitoring of patients 6 months postoperatively to detect subsequent chronic SDH recurrence.
