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Independent predictors for recurrence of chronic subdural hematoma

  • Clinical Article
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Abstract

Background

Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. In this study, we evaluated the independent risk factors of recurrence.

Methods

We analyzed data for 420 patients with chronic subdural hematoma treated by the standard surgical procedure for hematoma evacuation at our institution.

Results

Ninety-two (21.9 %) patients experienced at least one recurrence of chronic subdural hematoma during the study period. We did not identify any significant differences between chronic subdural hematoma recurrence and current antiplatelet therapy. The recurrence rate was 7 % for the homogeneous type, 21 % for the laminar type, 38 % for the separated type, and 0 % for the trabecular type. The rate of recurrence was significantly lower in the homogeneous and trabecular type than in the laminar and separated type. We performed a multivariate logistic regression analysis and found that postoperative midline shifting (OR, 3.6; 95 % CI, 1.618-7.885; p = 0.001), diabetes mellitus (OR, 2.2; 95 % CI, 1.196-3.856; p = 0.010), history of seizure (OR, 2.6; 95 % CI, 1.210-5.430; p = 0.014), width of hematoma (OR, 2.1; 95 % CI, 1.287-3.538; p = 0.003), and anticoagulant therapy (OR, 2.7; 95 % CI, 1.424-6.960; p = 0.005) were independent risk factors for the recurrence of chronic subdural hematoma.

Conclusions

We have shown that postoperative midline shifting (≥5 mm), diabetes mellitus, preoperative seizure, preoperative width of hematoma (≥20 mm), and anticoagulant therapy were independent predictors of the recurrence of chronic subdural hematoma. According to internal architecture of hematoma, the rate of recurrence was significantly lower in the homogeneous and the trabecular type than the laminar and separated type.

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Abbreviations

CSDH:

Chronic subdural hematoma

PT:

Prothrombin time

INR:

International normalized ratio

DM:

Diabetic mellitus

OR:

Odd ratio

CI:

Confidence interval

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Authors and Affiliations

  1. Department of Neurosurgery, Chonbuk National University Hospital & Medical School, 664-14, Deokjin-Gu, Jeonju, Jeonbuk, 561-756, Republic of Korea

    Kyu-Hyon Chon, Jong-Myong Lee, Eun-Jeong Koh & Ha-Young Choi

Authors
  1. Kyu-Hyon Chon
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  2. Jong-Myong Lee
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  3. Eun-Jeong Koh
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  4. Ha-Young Choi
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Corresponding author

Correspondence to Jong-Myong Lee.

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Comment

This is an important paper that deals with a common disease in the neurosurgical practice. The information on the recurrence rate and its prediction has a practical aspect. The independent recurrence rate on antiplatelet treatment is an important contribution to the decision-making on re-employment of antiplatelet treatment in patients after drainage of CSDH.

Moshe Hadani

Tel Hashomer, Israel

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Chon, KH., Lee, JM., Koh, EJ. et al. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir 154, 1541–1548 (2012). https://doi.org/10.1007/s00701-012-1399-9

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