Related Experiment Video
Updated: Jan 31, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Intracranial hemorrhage after evacuation of chronic subdural hematoma: systematic review
Rami Yuser1, Justyna Fercho2,3, Konrad Duszyński1
1Scientific Circle of Neurotraumatology, Department of Emergency Medicine, Medical University of Gdansk, Poland.
Insights
Intracranial hemorrhage (ICH) after chronic subdural hematoma (cSDH) surgery occurs in 2.3% of cases. Hypertension and antiplatelet therapy are linked to worse outcomes, emphasizing careful patient preparation and perioperative care.
Area of Science:
- Neurosurgery
- Neurology
- Public Health
Background:
- Intracranial hemorrhage (ICH) is a rare but severe complication following surgical evacuation of chronic subdural hematoma (cSDH).
- This complication significantly increases patient morbidity and mortality.
- Understanding ICH prevalence and risk factors is crucial for enhancing surgical safety.
Purpose of the Study:
- To determine the prevalence of post-operative ICH after cSDH evacuation.
- To analyze clinical features, risk factors, treatments, and outcomes of ICH in cSDH patients.
- To identify determinants of neurological status deterioration and recovery complications.
Main Methods:
- Systematic literature searches in PubMed, Scopus, and MEDLINE databases following PRISMA guidelines.
- Analysis of 18 articles for ICH prevalence.
- Detailed clinical data extraction from 56 articles for 76 patients with post-operative ICH.
Main Results:
- The prevalence of ICH post-cSDH surgery was found to be 2.3%.
- Intraparenchymal hemorrhage (IPH) was the most common type (73.7%), occurring a mean of 1.7 days post-procedure.
- Hypertension and antiplatelet therapy correlated with poorer outcomes (mRS > 3).
Conclusions:
- Patients with hypertension and on antiplatelet therapy may face poorer prognoses after cSDH surgery.
- Patient stratification by comorbidities and meticulous perioperative management are key to reducing ICH incidence.
- Improved patient preparation and care can enhance outcomes for cSDH surgical patients.
Introduction:
Intracranial hemorrhage (ICH) after surgical evacuation of chronic subdural hematoma (cSDH) is a rare but serious complication associated with considerable morbidity and mortality. This review aims to provide an updated estimate, from existing literature, of the prevalence of ICH and to analyze the clinical features, potential risk factors, treatment approaches, and outcomes in a cohort of 76 patients.
Clinical Rationale For The Study:
Because postoperative ICH can rapidly deteriorate neurological status and complicate recovery, understanding its prevalence and determinants is essential for improving safety in cSDH surgery.
Material And Methods:
Two systematic searches of the PubMed, Scopus, and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases were conducted in accordance with Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines on September 20th, 2025. The first search resulted in the inclusion of 18 articles, which were included in an analysis of the prevalence of ICH. The second search resulted in the inclusion of 56 articles, encompassing detailed clinical data on 76 patients who experienced postoperative ICH following surgical evacuation of cSDH.
Results:
The prevalence of ICH after cSDH surgery was 2.3%. Patients' ages ranged from 22 to 93 years (mean: 66.5 years), with 79% being male. The most common type of postoperative ICH was intraparenchymal hemorrhage (IPH) (73.7%), followed by subdural hemorrhage (14.5%). ICH occurred on average 1.7 days after the procedure. Dominant symptoms of ICH post evacuation included the following: altered mental status (47.4%), motor weakness (30.3%), and headache (21.05%). Significant correlations between preoperative hypertension, antiplatelet therapy, IPH, and worse outcome (mRS > 3) have been established.
Conclusion And Clinical Implications:
The data suggest that patients suffering from hypertension and using antiplatelet therapy may be predisposed to poorer outcomes. Stratification of patients based on comorbidities, scrupulous preparation of patients, and careful perioperative care may play a role in reducing ICH occurrence and improving patient prognosis.
Related Concept Videos
01:10Review and Preview
Percentiles are a type of fractile that partition data into...
01:13Review and Preview
01:20Random and Systematic Errors
01:17Systematic Sampling Method
Systematic sampling is one of the simplest methods...
01:10Propagation of Uncertainty from Systematic Error
01:15Systematic Error: Methodological and Sampling Errors
Sampling errors originate from improper sampling methods or the wrong sample population. These errors can be minimized by refining the sampling strategy. Defective instruments or faulty calibrations are the sources of instrumental...