Predictors for Recurrence of Chronic Subdural Hematoma.
OBJECTIVE
This prospective study was designed to analyze the dependence of different factors on the recurrence rate of chronic subdural hematoma (cSDH) after surgical treatment.


METHODS
Seventy-three consecutive patients, who were surgically treated at our department due to cSDH between 2009 and 2012, were included. The following parameters were analyzed: patient age and gender, occurrence of trauma, time between trauma and admission, neurological symptoms, presence of minor diseases, intake of anticoagulation medication. We classified the results of diagnostic imaging and determined the space-consuming effect via the cerebral midline shift. In addition, we scrutinized intraoperative findings and the dependence of the position of subdural drainage on the recurrence rate of cSDH.


RESULTS
In our patient group, cSDH recurrence was significantly associated with aphasia (p=0.008). Moreover an increased cSDH recurrence rate was observed in the patient group that had a separated manifestation of the cSDH in the preoperative diagnostic imaging (p=0.048) and received no drainage implant (p=0.016). Homogeneous isodense cSDH was associated with no apparent recurrence (p=0.037).


CONCLUSIONS
Within the scope of this study, we detected aphasia and separated cSDH as predictors of cSDH recurrence. Homogeneous isodense cSDH seems to be a good prognostic sign regarding the risk of recurrence development. Furthermore, our data clearly emphasize the importance of surgically applied drainage implants to prevent a recurrence of cSDH.
Paracelsus Medical University, Department of Neurosurgery, Nürnberg, Germany.
Alexander
A
Hammer
Alexander
A
Tregubow
Ghassan
G
Kerry
Michael
M
Schrey
Christian
C
Hammer
Hans-Herbert
HH
Steiner
D000328:Adult; D000368:Aged; D001037:Aphasia / Q000150:complications*; D004322:Drainage / Q000379:methods; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013355:Subdural Space / Q000601:surgery*