Work

Perioperative Predictors of Recurrency in Chronic Subdural Hematoma: A Retrospective Analysis of 150 Consecutive Cases

Year: 2025

Type: article

Abstract: OBJECTIVE: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with increasing incidence due to aging and widespread anticoagulant use. Mortality remains as high as 32%. Burr-hole evacuation with drainage is the standard treatment for uncomplicated cSDH, but recurrence is a major concern, potentially leading to serious outcomes. Identifying high-risk patients is essential to guide tailored strategies. METHODS: We conducted a retrospective single-center study on 150 consecutive patients treated surgically for cSDH at the Department of Neurosurgery, San Camillo Forlanini Hospital, Rome, Italy. Clinical and radiological data were collected, and reoperation for recurrence was recorded. Logistic regression was used to identify independent predictors and construct a risk stratification score. RESULTS: Logistic regression revealed cortical atrophy (odds ratio ˜ 5.77, P = 0.020) and delta midline shift (odds ratio per mm ˜ 0.78, P = 0.028) as independent predictors of recurrence. A risk score was derived by assigning 3 points for cortical atrophy, 2 points for delta shift ≤ 3 mm, 1 point for 4-7 mm, and 0 for ≥ 8 mm. Total scores (0-5) stratified patients into 4 categories (low: 0-1, moderate: 2-3, high: 4, and very high: 5), demonstrating good discrimination (area under the curve = 0.756). CONCLUSIONS: Cortical atrophy and limited postoperative midline re-expansion are independent predictors of cSDH recurrence. The proposed scoring system provides a practical tool for perioperative risk stratification, supporting early identification of high-risk patients and timely adoption of appropriate management strategies.

Source: World Neurosurgery

DOI: 10.1016/j.wneu.2025.124529