title: Risk Factors for Chronic Subdural Hematoma Recurrence Identified Using Quantitative Computed Tomography Analysis of Hematoma Volume and Density.
abstract: OBJECTIVE
  Chronic subdural hematoma (CSDH), a common condition in elderly patients, presents a therapeutic challenge with recurrence rates of 33%. We aimed to identify specific prognostic factors for recurrence using quantitative analysis of hematoma volume and density.
  
  
  METHODS
  We retrospectively reviewed radiographic and clinical data of 227 CSDHs in 195 consecutive patients who underwent evacuation of the hematoma through a single burr hole, 2 burr holes, or a mini-craniotomy. To examine the relationship between hematoma recurrence and various clinical, radiologic, and surgical factors, we used quantitative image-based analysis to measure the hematoma and trapped air volumes and the hematoma densities.
  
  
  RESULTS
  Recurrence of CSDH occurred in 35 patients (17.9%). Multivariate logistic regression analysis revealed that the percentage of hematoma drained and postoperative CSDH density were independent risk factors for recurrence. All 3 evacuation methods were equally effective in draining the hematoma (71.7% vs. 73.7% vs. 71.9%) without observable differences in postoperative air volume captured in the subdural space.
  
  
  CONCLUSIONS
  Quantitative image analysis provided evidence that percentage of hematoma drained and postoperative CSDH density are independent prognostic factors for subdural hematoma recurrence.
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany. Electronic address: pantelis.stavrinou@uk-koeln.de.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Stavrinou
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Katsigiannis
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Hamisch
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Krischek
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Mpotsaris
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Timmer
authors.affiliation: Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Goldbrunner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy; D004322:Drainage; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014207:Trephining
keywords: Chronic subdural hematoma; Computed tomography; Density; Multiple regression; Recurrence; Volume