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Risk Factors of Chronic Subdural Hematoma Recurrence: A Systematic Review
SeyedAhmad SeyedAlinaghi1,2, Esmaeil Mehraeen3, Farid Farahani Rad4
1Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
Medical Journal of the Islamic Republic of Iran
|November 6, 2025
Summary
Recurrence of chronic subdural hematoma (cSDH) is linked to inflammation, coagulation issues, and brain changes. Identifying these risk factors is key for better prevention and treatment strategies.
Area of Science:
- Neurosurgery
- Neurology
- Systematic Review
Background:
- Chronic subdural hematoma (cSDH) recurrence factors lack consistent findings.
- This study aims to identify cSDH recurrence risk factors and their biological mechanisms.
Purpose of the Study:
- To systematically review and synthesize current literature on chronic subdural hematoma recurrence.
- To develop an integrative framework linking clinical risk factors with underlying biological mechanisms.
Main Methods:
- Systematic literature search conducted in December 2024 across Scopus, Web of Science, PubMed, and Embase.
- 61 studies were selected based on eligibility criteria, with bias and methodological rigor assessed using NOS and PRISMA checklist.
Main Results:
- Key risk factors for cSDH recurrence include low Glasgow Coma Scale (GCS) scores, elevated neutrophils, antiplatelet/anticoagulant use, male sex, older age, larger hematoma size, and shorter drainage duration.
- Radiological signs (high density, midline shift), comorbidities (diabetes, hypertension), and inflammation/coagulation dysfunction contribute to recurrence.
- Reduced recurrence risk is associated with early detection, effective drainage, and higher serum HDL levels.
Conclusions:
- cSDH recurrence stems from a complex interplay of inflammation, coagulation dysfunction, and structural brain changes.
- Targeting these integrated pathways is essential for improving cSDH prevention and management.
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