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Updated: Sep 7, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Predictors of Neurological Outcome and Recurrence after Standardized Double Burr-hole Evacuation for Chronic Subdural
Saurabh Sharma1, Vaibhav Lakhanpal1, Jagminder Singh1
1Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Background:
Chronic subdural hematoma (CSDH) is increasingly common in older adults. Although burr-hole evacuation is effective, outcome and recurrence remain variable. This study evaluated the predictors of outcome and recurrence after a uniform double burr-hole technique.
Materials And Methods:
In this prospective observational study, 101 symptomatic CSDH patients admitted to Dayanand Medical College and Hospital, Ludhiana (July 2023-September 2024) underwent double burr-hole craniostomy with subdural drain. Demographic variables, comorbidities, antithrombotic use, alcohol intake, clinical status (Glasgow Coma Scale [GCS], Markwalder grade, and modified Rankin scale mRS), CT findings (density, thickness, midline shift, laterality, membranes, and cerebral atrophy), laboratory parameters (international normalized ratio [INR], serum albumin, and total proteins), intraoperative findings, complications, recurrence, and hospital stay were recorded. Outcomes were assessed using the Glasgow Outcome Scale (GOS) at discharge and at 2 months and dichotomized as favorable (GOS 5) or unfavorable (GOS 1-4).
Results:
The cohort was predominantly male (81.2%) and elderly. Favorable outcome was achieved in 78.2% at discharge and 84.2% at 2 months; recurrence occurred in 14.9%. Unfavorable discharge outcome was significantly associated with older age (P = 0.027), hypertension (P = 0.026), poorer neurological status (higher Markwalder grade, higher mRS, lower GCS; all P < 0.001), bilateral hematoma (P = 0.037), cerebral atrophy (P = 0.021), intraoperative membranes (P = 0.036), higher INR (P = 0.047), and lower serum albumin (P < 0.001) and total proteins (P = 0.002). Hematoma thickness and midline shift were not predictive. Recurrence was significantly associated with hypertension (P = 0.046), blood thinner use (P = 0.001), alcohol consumption (P < 0.001), and higher INR (P = 0.007). Recurrence strongly predicted unfavorable follow-up outcome (P < 0.001).
Conclusion:
After uniform double burr-hole evacuation, outcome and recurrence in CSDH are primarily influenced by baseline neurological status, vascular comorbidity, cerebral atrophy, membrane formation, and coagulation/nutritional markers, with antithrombotics and alcohol strongly increasing recurrence risk.