The risk factors for recurrence of chronic subdural hematoma

Abstract

Chronic subdural hematoma (CSDH) is a common disease in the elderly, and the recurrence rate of CSDH is reported to range from 2.3 to 33%. We performed a retrospective review of a number of CSDH cases and the potential factors associated with CSDH recurrence. The patient population comprised 112 men and 65 women with a mean age of 74.7 years. We analyzed the following factors: age, sex, antiplatelet and anticoagulant use, hematoma laterality, hematoma thickness, degree of midline shift and internal architecture of the hematoma in the preoperative CT films, use of irrigation, direction of the drainage tube, width of the subdural space, and degree of midline shift and the presence of a massive subdural air collection in the postoperative CT films. Univariate analysis revealed that there was a trend for different rates of recurrence among the different types of hematomas. The presence of a postoperative massive subdural air collection tended to be associated with the recurrence of hematoma. Multivariate analysis revealed that separated hematomas were significantly associated with CSDH recurrence, whereas the presence of postoperative massive subdural air collection tended to be associated with hematoma recurrence. Neither univariate nor multivariate analysis could demonstrate an association between the direction of the drainage tube and the recurrence of CSDH.

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

“…Multiple comorbidities, reduced physiological reserve, worse pre-morbid functional status, and the natural increased risk of death in very elderly people are all factors that are likely to contribute towards this. We also found that increasing age does not appear to be associated with increased recurrence risk, consistent with previous studies [9,12,[16][17][18][19][20].…”

Chronic Subdural Hematoma with Hypodense on CT-Scan in the Elderly: Surgical Drainage or Conservative Treatment

“…In concern to the clinical outcome, it is not clear which type of hematoma is suited for surgical drainage for each patient. Some advocated that the operating in the homogeneous stage of CSDH, may reduce the recurrence rate [6,17]. Others persisted that low density hematoma often lead to poor outcome after surgery, compared to other type of CSDH [7,18].…”

“…The role of hematoma density in CSDH recurrence has been studied previously, but the results have not been consistent [6,7]. Compared with high-or mixed-density of CSDH, hypodense hematoma is not an acute condition and it is rational to recommend for close observation.…”

A prospective comparative study of twist drill craniostomy versus burr hole craniostomy in patients with chronic subdural hematoma

“…This tool waived the time spent on insertion of a draining tube, further shortening the operating time. Free from tube insertion may also minimize the possibility of subdural air collection after surgery, which is recognized as a risk factor for CSDH recurrence (10,11,13). The recurrence rate in the patients treated by this technique was 18.4% in this study, comparable to 18.1% in Smely's study and 18.2% in Horn's study in which a subdural draining tube was placed when performing TDC (7,14).…”

“…The internal structure of the hematoma was classified into four types as previously described: homogenous, laminar, separate or trabecular (4,9,11). Continuous data were expressed in the mean ± standard deviation (SD) while categorical data was described as the percentage.…”