Chronic Subdural Hematoma: Predicting Postoperative Recurrence Using a Correlation of Computerized Tomographic Volume with Intraoperative Volume.

Abstract

Chronic subdural hematoma (CSDH) recurrence is the most common complication following surgery. To predict postoperative recurrence of CSDH using a correlation of the calculated preoperative brain computerized tomographic (CT) volume with the intraoperative volume. A prospective study was conducted over 14 months in a tertiary hospital in southwestern Nigeria. History with focused examination findings and patient grading using Markwalder classification were documented preoperatively. Preoperative CSDH CT volume was documented and compared with the intraoperative volume. Patients were followed up clinically for features of recurrence at 1, 3, and 6 months postoperatively, and repeat brain CT was done when recurrence was suspected clinically. Forty-seven out of 51 patients recruited completed the study, and four were lost to follow-up. Thirty-three (70.2%) were males, and the average age was 51.4 years. Most of the patients were in the 5th and 7th decades of life. Three patients had recurrence (6.5%), and one patient died (2.1%). Trauma was the most common cause of CSDH (35 out of 47 [74.5%]), spontaneous in 11 (23.4%), and anticoagulant related in 1 (2.1%) patient. Most patients (37/47; 78.7%) presented with headache. The mean brain CT volume and intraoperative volume of CSDH were 102.58 ± 54.13 and 87.74 ± 46.6 mL, respectively, with no significant difference between them (P = 0.104). The receiver operating characteristics curve of intraoperative volume predicted the recurrence of CSDH at a volume >130 mL, with a sensitivity of 66.7%. The calculated preoperative CT volume had a positive linear correlation with intraoperative volume. Intraoperative CSDH volume >130 mL was associated with an increased risk of recurrence.