Acta Neurochirurgica

, Volume 160, Issue 5, pp 893–899 | Cite as

Prevalence of and risk factors for recurrence of chronic subdural hematoma

  • Wendong You
  • Yuanrun Zhu
  • Yadong Wang
  • Wenchao Liu
  • Hao Wang
  • Liang Wen
  • Xiaofeng Yang
Original Article - Brain Injury



Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice with substantial recurrence rate. We aimed to estimate recurrence rate of CSDH and to identify risk factors for CSDH recurrence.


We retrospectively studied consecutive cases with CSDH and performed surgical therapy in our hospital. Univariate and multivariate logistic regression analyses were performed to identify factors associated with recurrence of CSDH.


A total of 226 patients with CSDH were included; 34 patients recurred after surgery with a recurrence rate of 15.0%. Univariate analysis showed that the recurrence group had more patients with homogenous hyper-dense hematoma (20.6 vs 6.3%, p = 0.035) and shorter duration of subdural drainage post-surgery (1.2 ± 1.4 vs 1.5 ± 0.9, p = 0.022) than the non-recurrence group. Logistic regression analysis revealed that duration of subdural drainage (OR = 0.66, p = 0.05) and hyper-dense of hematoma (OR = 4.94, p = 0.012) were independent predictors for CSDH recurrence.


Homogenous hyper-dense of hematoma and duration of subdural drainage post-surgery were independent predictors for CSDH recurrence; longer duration of postoperative subdural drainage was associated with lower risk of recurrence.


Chronic subdural hematoma Recurrence Prevalence Risk factors Hematoma density 



The authors sincerely thank all the doctors in the neurosurgery department of the First Affiliated Hospital of Zhejiang University College of Medicine for their help in conducting this research.

Compliance with ethical standards

The study was approved by the ethics committee of the First Affiliated Hospital, College of Medicine, Zhejiang University, and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Almenawer SA, Farrokhyar F, Hong C, Alhazzani W, Manoranjan B, Yarascavitch B, Arjmand P, Baronia B, Reddy K, Murty N, Singh S (2014) Chronic subdural hematoma management: a systematic review and meta-analysis of 34,829 patients. Ann Surg 259:449–457. CrossRefPubMedGoogle Scholar
  2. 2.
    Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, Esfandiari K, Shirani A, Asadollahi M, Aleali H (2007) Outcomes and recurrence rates in chronic subdural haematoma. Br J Neurosurg 21:272–275CrossRefPubMedGoogle Scholar
  3. 3.
    Chon KH, Lee JM, Koh EJ, Choi HY (2012) Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir 154:1541–1548. CrossRefPubMedGoogle Scholar
  4. 4.
    Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ (2017) Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 127:1117–1125. CrossRefPubMedGoogle Scholar
  5. 5.
    Jack A, O’Kelly C, McDougall C, Findlay JM (2015) Predicting recurrence after chronic subdural haematoma drainage. Canadian J Neurological Sci Le J Canadien Des Sci Neurologiques 42:34–39. CrossRefGoogle Scholar
  6. 6.
    Jeong SI, Kim SO, Won YS, Kwon YJ, Choi CS (2014) Clinical analysis of risk factors for recurrence in patients with chronic subdural hematoma undergoing burr hole trephination. Korean J Neurotrauma 10:15–21. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kiymaz N, Yilmaz N, Mumcu C (2007) Controversies in chronic subdural hematoma: continuous drainage versus one-time drainage. Medical Sci Monitor: Int Medical J experimental Clinical Res 13:Cr240–Cr243Google Scholar
  8. 8.
    Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH (2008) Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurgical Soc 43:11–15. CrossRefGoogle Scholar
  9. 9.
    Kolias AG, Chari A, Santarius T, Hutchinson PJ (2014) Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol 10:570–578. CrossRefPubMedGoogle Scholar
  10. 10.
    Kotwica Z, Brzezinski J (1991) Chronic subdural haematoma treated by burr holes and closed system drainage: personal experience in 131 patients. Br J Neurosurg 5:461–465CrossRefPubMedGoogle Scholar
  11. 11.
    Lin CC, Lu YM, Chen TH, Wang SP, Hsiao SH, Lin MS (2014) Quantitative assessment of post-operative recurrence of chronic subdural haematoma using mean haematoma density. Brain Inj 28:1082–1086. CrossRefPubMedGoogle Scholar
  12. 12.
    Lind CR, Lind CJ, Mee EW (2003) Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains. J Neurosurg 99:44–46. CrossRefPubMedGoogle Scholar
  13. 13.
    Lindvall P, Koskinen LO (2009) Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clinical Neuroscience: Official J Neurosurgical Soc Australasia 16:1287–1290. CrossRefGoogle Scholar
  14. 14.
    Nakaguchi H, Tanishima T, Yoshimasu N (2001) Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 95:256–262. CrossRefPubMedGoogle Scholar
  15. 15.
    Ohba S, Kinoshita Y, Nakagawa T, Murakami H (2013) The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 36:145–149. CrossRefPubMedGoogle Scholar
  16. 16.
    Santarius T, Hutchinson PJ (2004) Chronic subdural haematoma: time to rationalize treatment? Br J Neurosurg 18:328–332CrossRefPubMedGoogle Scholar
  17. 17.
    Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet (London, England) 374:1067–1073CrossRefGoogle Scholar
  18. 18.
    Schwarz F, Loos F, Dunisch P, Sakr Y, Safatli DA, Kalff R, Ewald C (2015) Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas. Clin Neurol Neurosurg 138:66–71. CrossRefPubMedGoogle Scholar
  19. 19.
    Stanisic M, Hald J, Rasmussen IA, Pripp AH, Ivanovic J, Kolstad F, Sundseth J, Zuchner M, Lindegaard KF (2013) Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients. Acta Neurochir 155:323–333. CrossRefPubMedGoogle Scholar
  20. 20.
    Stanisic M, Pripp AH (2017) A reliable grading system for prediction of chronic subdural hematoma recurrence requiring reoperation after initial burr-hole surgery. Neurosurgery 81:752–760. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S (2008) Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 63:1125–1129. CrossRefPubMedGoogle Scholar
  22. 22.
    Tsutsumi K, Maeda K, Iijima A, Usui M, Okada Y, Kirino T (1997) The relationship of preoperative magnetic resonance imaging findings and closed system drainage in the recurrence of chronic subdural hematoma. J Neurosurg 87:870–875. CrossRefPubMedGoogle Scholar
  23. 23.
    Wakai S, Hashimoto K, Watanabe N, Inoh S, Ochiai C, Nagai M (1990) Efficacy of closed-system drainage in treating chronic subdural hematoma: a prospective comparative study. Neurosurgery 26:771–773. CrossRefPubMedGoogle Scholar
  24. 24.
    Weigel R, Schmiedek P, Krauss JK (2003) Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 74:937–943. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Yu GJ, Han CZ, Zhang M, Zhuang HT, Jiang YG (2009) Prolonged drainage reduces the recurrence of chronic subdural hematoma. Br J Neurosurg 23:606–611. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Wendong You
    • 1
  • Yuanrun Zhu
    • 1
  • Yadong Wang
    • 1
  • Wenchao Liu
    • 1
  • Hao Wang
    • 1
  • Liang Wen
    • 1
  • Xiaofeng Yang
    • 1
  1. 1.Department of Neurosurgery, First Affiliated Hospital, College of MedicineZhejiang UniversityHangzhouChina

Personalised recommendations