Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study.

Fabio Cofano,Mauro Palmieri,Giovanni Vercelli,Alessandro Frati,Diego Garbossa,Giancarlo D'Andrea,Alessandro Pesce,Massimiliano Minardi,Armando Massara,Francesco Zenga,Fulvio Tartara,Michele Maria Lanotte,Chiara Fronda,Marco Mammi

doi:10.3389/fneur.2020.560269

Abstract

Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.Objective: To identify factors associated with increased risk of recurrence.Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes.Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013).Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.

Highlights

Chronic Subdural Hematoma (CSDH) is a common condition affecting the elderly population (>65 years)
Burr-hole, twist drill, or craniotomy with or without drain placement are usually considered the surgical treatments of choice [3]
The results of the present study showed a higher risk of recurrence when extended craniectomy or craniotomy was performed

Summary

Introduction

Chronic Subdural Hematoma (CSDH) is a common condition affecting the elderly population (>65 years). Risk factors for recurrence are still debated and there is no universal consensus regarding the best surgical technique or optimal preand postoperative management [6, 7]. The possible impact of recurrences after surgical treatment of a CSDH on the overall fatality rate is extensively debated [8], in most investigations and in the practical clinical situation of extremely old patients suffering from multiple major comorbidities, reliable information concerning the “disease specificity” profile of the fatality rate of CSDH recurrences appear to be still elusive and difficult to collect [8]. Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%.

Methods

Results

Discussion

Conclusion