Cases Of Chronic Subdural Hematoma Research Articles

Decline in the Incidence of Chronic Subdural Hematoma During the Coronavirus Disease 2019 Pandemic: A Retrospective Single-Center Descriptive Study.

The coronavirus disease 2019 (COVID-19) pandemic has forced restrictions on social activities in some areas. There has also been a decrease in the number of trauma patients in the United States during the COVID-19 pandemic. Chronic subdural hematoma (CSDH) is a traumatic disorder that often develops following head injury. We therefore investigated the impact of the COVID-19 pandemic on CSDH. In this retrospective single-center descriptive study from April 2018 through September 2021, there were 5,282 head trauma patients and 196 patients with CSDH in the pre-pandemic group compared to 4,459 head trauma patients and 140 patients with CSDH in the intra-pandemic group. Significant decreases in the incidence rate (IR) of head trauma (951/100,000 vs. 795/100,000 person-years; IR ratio (IRR): 0.836, 95% confidence interval (CI): 0.803–0.870, p < 0.001) and also in the IR of CSDH (35.0/100,000 vs. 24.8/100,000 person-years, IRR: 0.708, 95% CI: 0.570–0.879, p = 0.002) were seen in the intra-pandemic group compared to the pre-pandemic group. In this study, the COVID-19 pandemic was associated with significant decreases in the IRs of head trauma and CSDH due to forced restrictions on social activities. Besides, the IR of mild cases of CSDH was significantly lower in the intra-pandemic group than in the pre-pandemic group (IRR: 0.68, 95% CI: 0.51–0.89, p = 0.006). Fewer people being out in communities should result in fewer chances for head trauma and CSDH. On the other hand, forced restrictions on social activities due to the COVID-19 pandemic should aggravate CSDH.

Middle meningeal artery embolization with N-Butyl Cyanoacrylate (NBCA) for the treatment of chronic subdural hematoma – Technical note

Chronic subdural hematoma (cSDH) is classically defined as a collection of blood in the space between the dura mater and arachnoid meninges. Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the middle meningeal artery (MMA) the most used technique, though the best embolization material is still subject to studies. Methods: we present the detailed description of the technique for MMA embolization with a 20% solution of NBCA for the treatment of chronic subdural hematoma. Discussion: Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the MMA the most used technique, though the best embolization material is still subject to studies. NBCA is a low-cost embolic agent that has been used for a long time in endovascular treatments. Conclusion: There is great potential for MMA embolization in the management of chronic subdural hematomas, either as a single or adjuvant treatment. NBCA represents an effective and low-cost material.

Experience with Atorvastatin in Conservative Management of Chronic Subdural Hematoma with Brief Review of Literature

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedure done in any neurosurgical unit worldwide. The majority of CSDH are operated upon and there are very few studies regarding its conservative management. Mannitol, Steroids, Tranexemic acid, middle meningeal artery embolization and Angiotensin Converting Enzyme inhibitors are some options to treat CSDH conservatively. Atorvastatin is one of the newer and novel drugs that has been used effectively to medically treat CSDH.&#x0D; This is a retrospective study of 20 cases of CSDH that were managed conservatively with atorvastatin between 2015 to 2021.&#x0D; A total of 20 (7.5%) cases were included in the study period (January 2015 – January 2021). Glasgow Coma Score (GCS)/ Markwalder score (MS), mode of injury if any, age, sex, symptoms and neurological findings, co-morbidities, anti-platelet use, radiological finding of midline shift at admission and outcome with Glasgow outcome score (GOS) at the end of two months after treatment recorded. Atorvastatin in dose of 20 mg daily was given for maximum of two months with repeat CT/MRI scans done at 2 months. Repeat scan was done at 2 weeks and at 2 months and all of them showed complete resolution of the CSDH radiologically. The Glasgow outcome score showed good improvement in all the cases although there was mild confusion in five of the elderly which can be attributed to age related behavior changes.&#x0D; We conclude that atorvastatin can be used safely in not only elderly but also in younger subjects.

Comparing the outcome of 3 different types of operative techniques practiced for chronic subdural hematoma

Chronic subdural hematoma is a common condition of the neurosurgical department requiring surgical intervention. This is a retrospective study of Fifty cases of chronic subdural hematoma (CSDH) patients treated at SGT Medical College, Hospital, and Research Institute were enrolled in this study. The patients were divided into three groups based on the surgical technique performed: single bur-hole drainage (group A, n=40), double bur-hole drainage (group B, n=5), or craniostomy[Twist drill] with evacuation of hematoma (group C, n=5). The results of this study shows that craniostomy[Twist drill] with the evacuation of hematoma in CSDH patients significantly reduced the risk of recurrence, regardless of the number of burr holes used. We, therefore, recommend the use of craniostomy[Twist drill] with the evacuation of hematoma in CSDH patients.

Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence.

Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH. We retrospectively analyzed the charts of 172 CSDH patients treated with bedside twist drill craniostomy (TDC) and subdural drain insertion. Patients were divided into two groups: group A (n = 123) received a pediatric size nasogastric tube [NGT]), whereas group B (n = 49) had a drain commonly used for external ventricular drainage (EVD). Various demographic and radiologic data were collected. Our main outcome was recurrence, defined as symptomatic re-accumulation of hematoma on the previously operated side within 3 months. In all, 212 cases of CSDH were treated in 172 patients. The majority of patients were male (78%) and had a history of previous head trauma (73%). Seventeen cases had recurrence, 11 in group A and 6 in group B. The use of antiplatelet and anticoagulation agents was associated with recurrence (p = 0.038 and 0.05, respectively). There was no difference between both groups in terms of recurrence (odds ratio [OR] = 1.42; 95% confidence interval [CI]: 0.49-4.08; p = 0.573). CSDH is a common disease with a high rate of recurrence. Although using a drain postoperatively has shown to reduce the incidence of recurrence, little is known about the best type of drain to use. Our analysis showed no difference in the recurrence rate between using the pediatric size NGT and the EVD catheter post-TDC.

Endoscope-assisted Manipulation of Chronic Subdural Hematomas Provides a Novel Solution for Eliminating the Septum and Inner Membrane Leading to Reduced Recurrence.

Canonical burr-hole craniostomy (BHC) with drainage is the primary treatment for chronic subdural hematomas. However, complicated situations such as organized clots or compartmentation may result in recurrent chronic subdural hematoma (CSDH). Herein, we introduce a novel technique by applying an endoscope for tearing the inner membrane and septum, in addition to evacuating the hematoma in the subdural space where in-line visualization is not possible. Two hundred and twenty-nine cases of CSDH were enrolled in this study. Of these, 13 patients were treated endoscopically. The 0-degree and 30-degree, 2.7 mm endoscope was applied after a BHC. The arachnoid knife for microsurgery was used to tear the inner membrane to open the compartments. Non-endoscope-assisted operated (non-Endo group) and endoscope-assisted membranectomy patients (Endo group) demonstrated no differences in sex, age, body mass index, trauma, other diseases, or use of anticoagulation agents. Although the surgery time spent for the Endo patients was longer (128.53±49.56 min) than that for the non-Endo group (65.18±32.89 min), no recurrence was found among the Endo group, whereas a higher rate was observed in the non-Endo group. Novel endoscope-assisted membranectomy is a powerful technique capable of reducing recurrence and improving surgical outcomes.

Retrospective analysis of 195 surgically treated cases of chronic subdural hematoma.

The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition. We retrospectively analysed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018. The average age of the patients was 65.7 ± 19.6 years. The most common symptom was headache (53.3%). The case background was the use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was 13.4 ± 2.9, early postop 13.8 ± 2.5, and late postop was 14.6 ± 1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of the brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH. CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.

The first historical description of chronic subdural hematoma: A tale of inaccurate interpretation, inaccurate quoting and inaccurate requoting

ABSTRACT Most historical articles have named Johann Jacob Wepfer as the first author to describe a case of chronic subdural hematoma (CSDH). However, the question arises whether these cases truly describe CSDH. Two other names that appear in literature as the first authors to describe a case of CSDH are Thomas Willis and Giovanni Battista Morgagni. In our attempt to find the first description of a CSDH, we studied the original cases described by Willis, Wepfer, and Morgagni. The cases described by Willis and Wepfer cannot be interpreted as cases of CSDH. Willis’s university scholar is more likely to have experienced venous infarction with an underlying septic thrombosis than a CSDH. Wepfer’s cases seem to represent an intraparenchymal hemorrhage from the rupture of a branch or branches of the internal carotid artery, a subarachnoid hemorrhage complicated with hydrocephalus, and a hydrocephalus in tuberculous meningitis. Morgagni’s case described in Letter III, Article 20 in the Sedibus in 1761 seems to be the first accurate historical description of a CSDH, and we believe it should be cited as such. With these early cases of alleged CSDH, we emphasize the importance of misquotation and blind copying of references, which are important citation errors.

Twist drill aspiration of chronic subdural hematoma at the Ignace Deen hospital of Conakry

Bedside percutaneous twist drill aspiration (TDA) is described as a surgical method of management of Chronic subdural hematoma (CSDH) and appear to be a reasonable approach in low medical resources environment. We report the results of TDA of CSDH in a single tertiary centre in Conakry Republic of Guinea in West Africa, for the period March 2015 to October 2017. The charts and medical record of 38 cases of CSDH treated with TDA were collected retrospectively, with a mean follow-up of 84.2 days. The outcome data assessed were neurologic status evaluated by the follow-up Markwalder grading scale (MGS: 0=normal to 4=coma), recurrence, infection and mortality. The Male-Female ratio was 1.3:1. Mean age at diagnosis was 78.2+/-12 years. Traumatic brain injury (TBI) was identified as causal in 28.2% of cases studied. All patients were operated on under local anesthesia and had a postoperative drain left in place for 3 days. The mean postoperative MGS was 1.06, up from a mean preoperative MGS of 3.7. Two cases of recurrence occurred subsequent to TDA causing death and three other patients died from unknown causes during the follow-up period. No cases of post-operative infection were diagnosed during the follow-up. Our study shows that Bedside TDA appears to be a suitable alternative to burr hole craniotomies in urgent cases of CSDH in the low socio-economic setting, where a surgical theatre is not always available.

Single Burrhole Craniostomy with Subdural Placement of Foley Catheter for Drainage of Chronic Subdural Hematoma

Objective: Chronic subdural hematoma (CSDH) is a common neurosurgical condition of the elderly. The lack of consensus over a single standard surgical procedure for the management of CSDH urges neurosurgeons to evaluate different techniques in terms of a better outcome.&#x0D; Material &amp; Methods: In this prospective study forty cases of CSDH who had undergone single burr-hole craniostomy and subdural placement of Foley catheter were analyzed. The observations were made concerning clinical, radiological findings, postoperative complications, and mortality rate.&#x0D; Results: The study included 26 males and 14 females with a mean age of 67 years. The most common presenting symptom was hemiparesis (n=18, 45%). Recurrent hematoma and recurrent evacuation rate was 10%. There was no case of newly developed postoperative seizures, pneumocephalus, intracranial hemorrhage, and wound infection. The mortality rate during the study was 0.0%. The mean Glasgow outcome score (GOS) at the time of discharge was 4.8.&#x0D; Conclusion: We concluded that single burr-hole evacuation of CSDH with Foley catheter placement appears to be an effective procedure with a significant reduction in postoperative pneumocephalus. Factors such as sudden decompression of hematoma, the air in the subdural cavity, misplacement of drainage tubes, and damage to blood vessels during surgery can be reduced with this technique.

Relationship between CT scan density and hematoma age on chronic subdural hematoma cases

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Comparative Study of Subgaleal and Subdural Closed Drain in Surgically Treated Cases of Chronic Subdural Hematoma.

Background:Chronic subdural hematoma (CSDH) is seen most common in geriatric patients, and trauma is the most important reason for CSDH. Operative treatment of CSDH in symptomatic patients is yet the gold standard of therapy because it allows decompression of the subdural space and aids improvement in neurological status. Burr-hole craniostomy is the most common accepted treatment for CSDH. There is still controversy regarding which type of drain placement is best in the outcome: subdural or subgaleal drain.Aim:The aim of the study was to compare the outcome of subgaleal versus subdural drain in surgically treated patients of CSDH.Materials and Methods:Patients were assigned by simple random sampling in two groups. The study was conducted from February 2016 to July 2017. A total of 70 patients were enrolled into the study and were divided in two groups (Group 1 – Subgaleal drain; Group 2 – Subdural drain). Statistical analysis was done using Chi-square and t-test. Outcome was assessed at the end of hospital stay by modified Rankin scale. Postoperative computed tomography scan was done after 24 h of surgery.Results:This study concluded that both types of drains are equally effective for the treatment of CSDH. There is a statistically significant difference in the occurrence of seizure in both the groups as there was no seizure in subgaleal drain group compared to 5 (14.3%) patients who had seizures postoperatively in subdural drain group (P = 0.020). There was insignificant difference with respect to preoperative Glasgow Coma Scale/sex/preoperative hematoma volume/postoperative hematoma volume/preoperative midline shift.Conclusion:Subgaleal drain is safe and technically easy, as subgaleal drain has no direct contact with brain parenchyma, thus less chances of brain laceration, intracerebral hematoma formation, and seizures.

Management of Idiopathic Chronic Hydrocephalus of the Adult in Guinea: A Prospective Study in 16 Patients

Object: Incidence of Idiopathic chronic hydrocephalus of the adult (ICHA) is increasing in Guinea due to the aging of the population. The goal of this study was to describe its epidemiology, clinical presentation, and surgical outcome in a low-resource medical environment. Method: Sixteen patients operated for a probable ICHA were prospectively studied according to a uniform protocol from June 2019 to December 2020. On computerized tomography, all operated patients had a clinical triad of gait disturbance, incontinence, dementia associated with ventriculomegaly, and transependymal edema. In addition, all patients underwent a single lumbar tap, improved clinically, and were subsequently offered a shunt consisting of a simple catheter in 37.5% and a non-adjustable high-pressure valve in 62.5%. Result: The mean age was 68.31 ± 10.4 (range 49 - 89). The sex ratio H/F was 1.67/1. Clinically, the most frequent comorbidity was a combination of hypertension and diabetes in 56.5% of cases. The mean time to diagnosis was 8.31 ± 2.75 months (range 3 - 14). The immediate postoperative mortality was 12.5% from a status epilepticus and pulmonary sepsis. In addition, we observed 2 cases of chronic subdural hematoma (12.5%) and 2 cases of shunt dysfunction (12.5%) in the first three months. The functional outcome was good in 23% of patients at one month (N = 13), 50% at three months (N = 10), and 87.5% at six months (N = 8). Conclusion: In carefully selected cases, the surgical outcome of ICHA in Guinea is comparable to high-income countries. Efforts need to be put in helping patients get covered with universal insurance and generally promote Neurosurgery in the country to improve the quality of care.

A Case of Chronic Subdural Haematoma, A Rare Complication of Eclampsia in Pregnancy

Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. Chronic subdural hematoma is extremely uncommon in Pregnancy. Intracranial haemorrhage (ICH) is deadly complication, if it occurs in pregnancy both mother and fetus gets compromised. Here we present a rare case of Subdural Hematoma in a patient with eclampsia in pregnancy, in which both the mother and baby were discharged with a multidisciplinary approach and early detection of the condition.

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

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.

The Outcome of Medical Management of Chronic Subdural Hematoma with Tranexamic Acid – A Prospective Observational Study

IntroductionThe conservative management of Chronic subdural hematoma (CSDH) is controversial. Many drugs have been tried in the conservative management of CSDH. Tranexamic acid (Txa) is one such drug in the armamentarium for conservative management of CSDH. We conducted a prospective observational study about treatment of CSDH with Txa. Material and methodsThe study was conducted over three years. The clinical grading was assessed by the Markwalder grading system. All patients who were relatively and mildly symptomatic and willing for conservative management were recruited for the study. All patients were given Txa in the dosage of 750 mg/day in divided doses. The patients were followed up in the neurosurgery out-patient department. ResultsThere were 27 patients with 30 CSDH during this period who were treated with Txa. There were 20 cases of primary CSDHs and 7 cases of recurrent CSDHs following surgery that were enrolled in the Txa group. The mean volume of treated CSDH was 135.62 ± 92.90 SD. The mean thickness of CSDH enrolled in the study was 14.31 ± 5.47 SD. The mean number of days the patients treated with Txa was 64.83 ± 24.8 SD. There were no complications in any of the patients. All patients had good resolution of the hematomas, and none of the hematomas progressed during conservative treatment. ConclusionThe conservative management of CSDH with Txa is both a safe and effective alternative in the absence of life-threatening symptoms.

Middle meningeal artery embolization for chronic subdural hematoma with high risk of recurrence: A single institution experience

BackgroundMiddle meningeal artery (MMA) embolization can be a treatment option for selected cases of chronic subdural hematoma (CSDH) patients. However, appropriate timing of this procedure or the conditions to be considered are still not standardized. MethodsBetween 2008 and 2018, 18 symptomatic CSDH patients underwent MMA embolization at our institution. The timing of embolization and the risk factors for recurrence of CSDH, the recurrence rate after an embolization, and the complication were thoroughly reviewed. ResultsOf the 18 cases, 16 patients were male. The median age at MMA embolization was 78.5 years (range, 66–98 years). The median follow-up period were eight months (range, 2–53 months). Possible risk factors for CSDH recurrence harbored by those patients were age > 74 yrs (10), brain atrophy (4), separated hematoma (3), coagulopathy (3), anticoagulant administration (3), and thrombocytopenia (1). No recurrence or complication was observed in any of the patients after the embolization. ConclusionsMMA embolization is effective and safe in preventing recurrence of CSDH with high risk of recurrence, and could be a standard treatment for such cases.

Morphological characteristics of infected subdural hematoma: Comparison with images of chronic subdural hematoma

ObjectivesInfected subdural hematoma (ISH) is a rare type of subdural empyema, with fewer than 50 cases reported to date. Its radiological features have not been adequately described, making diagnosis challenging. At our institution, two adults presented with ISH, which exhibited a characteristic shape on preoperative imaging. Patients and methodsThis study examined ISH cases and chronic subdural hematoma (CSH) cases that underwent surgery at the Ishikawa Prefectural Central Hospital between January 2016 and March 2018. To distinguish ISH from CSH, we focused on three specific radiological features: the biconvex shape of the hematoma, presence of a high-density region at the lower end of the hematoma on plain computed tomography (CT), and presence of a hyper-intense signal within the hematoma on diffusion weighted imaging (DWI). ResultsWe analyzed 30 ISH (current and previously reported) and 102 CSH cases in our study. We found no statistically significant associations between the hematoma type (ISH or CSH) and the presence of a high-density region at the lower end of the hematoma on plain CT (p = 0.13) or the presence of hyperintensity in the hematoma on DWI (p = 1.00). Conversely, a statistically significant association was found between the hematoma type and the biconvex shape of the hematoma (p < 0.01). ConclusionThese results suggest that the shape of the hematoma on imaging provides valuable information that can be used to differentiate ISH from CSH and optimize therapeutic approaches.

Role of the patient comorbidity in the recurrence of chronic subdural hematomas.

Chronic subdural hematoma (CSDH) is an old blood collection between the cortical surface and the dura. Recurrence of CSDH after surgical evacuation occurs in up to a quarter of patients. The association between patient premorbid status and the rate of recurrence is not well known, and some previous results are contradictory. We aim to determine the impact of patient comorbidities in the risk of recurrence after surgical evacuation of CSDH. Retrospective data of a single institution's surgically evacuated CSDH cases followed up for at least 6months were analyzed, and univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, gender, CSDH thickness, neurological impairment at admission (NIHSS score), location of the CSDH (unilateral vs bilateral), Charlson Comorbidity Index (CCI), prothrombin time (PT), hemoglobin levels, and platelet count. A total of 90 patients (71 men and 19 women), aged 41-100years (mean age, 76.4 ± 11.2years), were included. CSDH recurred in 17 patients (18.9%). A higher CCI correlated with higher scores in the NIHSS. In the univariate analysis, recurrence was associated with a higher CCI (2.39 vs 1.22, p = 0.002), higher NIHSS scores (6.5 vs 4, p = 0.034), and lower PT levels (9.9 vs 13.4, p = 0.007). In multivariate analysis, only PT and CCI demonstrated to be independent risk factors for CSDH recurrence after surgical evacuation (p = 0.033 and p = 0.024, respectively). Patients with more comorbidities have a higher risk of developing recurrent CSDH. CCI provides a simple way of predicting recurrence in patients with CSDH and should be incorporated into decision-making processes, when counseling patients.

Double-crescent sign as a predictor of chronic subdural hematoma recurrence following burr-hole surgery.

Subdural hygroma has been reported as a causative factor in the development of a chronic subdural hematoma (CSDH) following a head trauma and/or neurosurgical procedure. In some CSDH cases, the presence of a 2-layered space delineated by the same or similar density of CSF surrounded by a superficial, residual hematoma is seen on CT imaging after evacuation of the hematoma. The aims of the present study were to test the hypothesis that the double-crescent sign (DCS), a unique imaging finding described here, is associated with the postoperative recurrence of CSDH, and to investigate other factors that are related to CSDH recurrence. The authors retrospectively analyzed data from 278 consecutive patients who underwent single burr-hole surgery for CSDH between April 2012 and March 2017. The DCS was defined as a postoperative CT finding, characterized by the following 2 layers: a superficial layer demonstrating residual hematoma after evacuation of the CSDH, and a deep layer between the brain's surface and the residual hematoma, depicted as a low-density space. Correlation of the recurrence of CSDH with the DCS was evaluated by multivariate logistic regression modeling. The authors also investigated other classic predictive factors including age, sex, past history of head injury, hematoma laterality, anticoagulant and antiplatelet therapy administration, preoperative hematoma volume, postoperative residual hematoma volume, and postoperative brain reexpansion rate. A total of 277 patients (320 hemispheres) were reviewed. Fifty (18.1%) of the 277 patients experienced recurrence of CSDH within 3 months of surgery. CSDH recurred within 3 months of surgery in 32 of the 104 hemispheres with a positive DCS. Multivariate logistic analyses revealed that the presence of the DCS (OR 3.36, 95% CI 1.72-6.57, p < 0.001), large postoperative residual hematoma volume (OR 2.88, 95% CI 1.24-6.71, p = 0.014), anticoagulant therapy (OR 3.03, 95% CI 1.02-9.01, p = 0.046), and bilateral hematoma (OR 3.57, 95% CI 1.79-7.13, p < 0.001) were significant, independent predictors of CSDH recurrence. In this study, the authors report that detection of the DCS within 7 days of surgery is an independent predictive factor for CSDH recurrence. They therefore advocate that clinicians should carefully monitor patients for postoperative DCS and subsequent CSDH recurrence.