Clinical Outcome and Recurrence Risk of Chronic Subdural Hematoma After Surgical Drainage

Abstract

IntroductionChronic subdural hematoma (CSDH) is one of the most encountered neurosurgical cases. CSDH is defined as the accumulation of liquified blood products in the space between the dura and the arachnoid. A reported incidence of 17.6/100,000/year has more than doubled in the past 25 years in parallel with an aging population. Surgical drainage remains the mainstay of treatment, yet it is challenged by variable recurrence risks. Less invasive embolization methods of the middle meningeal artery (EMMA) could reduce the recurrence risks. Before adopting a newer treatment (EMMA), it is prudent to establish the outcomes from surgical drainage. The purpose of this study is to assess the clinical outcome and recurrence risk in surgically treated CSDH patients in our center. MethodsA retrospective search of our surgical database was done to identify CSDH patients undergoing surgical drainage in the year 2019-2020. Demographic and clinical details were collected, and quantitative statistical analysis was performed. Peri-procedural radiographic information and follow-ups were also included as per the standard of care. ResultsA total of 102 patients (mean age: 69 years; range: 21-100 years; male: 79) with CSDH underwent surgical drainage with repeat surgery in 13.7% of the patients (n=14). Peri-procedural mortality and morbidity were 11.8%(n=12) and 19.6% (n=20), respectively. Overall, among our patient population, recurrence was seen in 22.55% (n=23). The mean total hospital stay was 10.6 days. ConclusionsOur retrospective cohort study showed an institutional CSDH recurrence risk of 22.55%, in keeping with what is reported in the literature. This baseline information is important for a Canadian setting and provides a basis for comparison for future Canadian trials.

Efficacy and Safety of Middle Meningeal Artery Embolization for Patients with Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

“…However, the rate of perioperative complications and mortality observed in CSDH cohorts varies from 0% to 32%. These complications are not always caused by the surgical procedure itself but are secondary to other factors such as preexisting active medical conditions and frailty 18,19 . MMA embolization, which is typically done endovascularly, is well tolerated and is also considered safe.…”

Delayed Recognition, Surgical Dilemmas, and Complications: A Case Report of Acute-on-Chronic Subdural Hematoma With Ischemic Stroke

“…Embolization of MMA is a new management option that lacks supporting evidence over surgical management; however, it is a safe option when used in conjunction with surgical management to decrease the recurrence rate [ 5 , 14 ]. Even so, it has some complications; treatment failure is the most common one, which can result in worsening of the hematoma and neurological deficits.…”

Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients

“…Research has shown that using a drainage tube significantly reduces recurrence rates compared to treatments without it [ 8 ]. A retrospective cohort study of 102 patients with cSDH showed that the risk of mortality and recurrence was 14.5% and 32% for patients undergoing craniotomy compared to only 8.7% and 17.7% of patients receiving burr hole drainage treatment, respectively [ 8 ]. Despite the presence of various drainage methods, subdural drainage remains prevalent.…”