Volumetric assessment in chronic subdural hematoma: a predictor of recurrence and guide for adjunctive therapy

Chronic subdural hematoma (cSDH) is the most common form of intracranial hemorrhage, with increasing incidence in older population. Despite surgical interventions, recurrence rates remain high, varying between 5 and 37%. Identifying predictors of recurrence, particularly preoperative volumetric thresholds, could change treatment strategies such as middle meningeal artery (MMA) embolization. In this study, 104 patients undergoing burr-hole craniotomy were analyzed. Patients with bilateral hematomas or insufficient radiological data were excluded. Hematoma volume was assessed preoperatively and during follow-up, with recurrence defined as requiring reoperation. While no significant gender differences were found in recurrence rates or hematoma characteristics, preoperative hematoma volume (p = 0.024) and follow-up volume (p < 0.001) were significantly associated with recurrence. Using ROC analysis, a cutoff preoperative volume of 112 mL for females and 130 mL for males was identified, predicting recurrence with high specificity (88.9% in females, 87.5% in males). These findings highlight the importance of volumetric assessment in predicting cSDH recurrence. Integrating these thresholds into clinical decision-making may guide the use of adjunctive therapies, such as MMA embolization, in high-risk patients.