Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

Abstract

Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.Objective: To identify factors associated with increased risk of recurrence.Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes.Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013).Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.

The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort

“…The recurrence rate of operated CSDHs in this population-based cohort was 15.8%, which is in line with previous studies reporting a recurrence risk from 6 to 29% [ 4 , 8 – 10 , 12 – 14 , 17 , 20 , 21 , 28 , 41 , 43 , 44 , 52 , 54 ]. A regression analysis revealed that male gender and a bilateral hematoma are independent risk factors for recurrence, latter of which has been generally recognized also in previous literature [ 32 ].…”

The Efficacy of Adjuvant Corticosteroids in Surgical Management of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

“…The study flow chart is presented in Figure 1. A total of 11 studies met the inclusion criteria (13)(14)(15)(19)(20)(21)(22)(23)(24)(25)(26). In all the included studies 100% of patients underwent surgical intervention in both intervention and control arms, except for one.…”

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

“…The authors concluded that twist drill and burr hole craniostomy can be considered first-tier treatment, while craniotomy may be used as second-tier treatment. Cofano et al examined recurrence rates after surgery in a 2020 multicenter cohort study and concluded that burr hole craniostomy is associated with lower recurrence rates, when compared to operative methods (9.3 vs. 18.8%, respectively) [ 32 ]. A 2022 RCT comparing BHC, mini-craniotomy and TDC concluded that all three techniques are effective in treating patients, with 6-month outcomes being similar [ 33 ].…”