Clinical and Radiological Characteristics for Recurrence of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis

Abstract

Chronic subdural hematoma (cSDH) is one of the most studied clinical entities in the neurosurgical literature. Management of cSDH is complicated by its propensity to recurrence. Various factors for the development of recurrence of cSDH have been described in various clinical, epidemiological, and observational studies, yet the evidence available is limited. A systematic review and meta-analysis as per PRISMA guidelines to identify clinical and radiological factors which can predict the development of recurrence in cSDH. A total of 14 studies were included for the systematic review and meta-analysis after a comprehensive search of the online databases. Eight studies were of high methodological quality. Age, use of anticoagulants, obesity, seizure, and liver disease were found to be statistically significant clinical risk factors for the development of recurrence in cSDH. Among the radiological parameters, the internal structure of the hematoma and the width of the hematoma was found to be significant risk factor predicting the development of recurrence. Age >75 years, use of anticoagulation therapy, liver disease, and obesity were significant risk factors for cSDH recurrence. Pneumocephalus, internal architecture of hematoma, bilateral cSDH, the width of hematoma, and the presence of bilateral cSDH are important radiological parameters of the development of recurrent cSDH

Surgical evacuation for chronic subdural hematoma: Predictors of reoperation and functional outcomes

“…We observed an acceptable reoperation rate (12.6 %) compared to a wide range of reported recurrence rates of 5–33 %. 3 , 7 , 8 , 9 , 10 However, the literature is heterogenous, as some studies report recurrence as reaccumulation requiring evacuation. According to Lakomkin et al, 3 the most common cause of readmission after CSDH evacuation was recurrent SDH (46.7 %).…”

“… 5 , 6 The reported recurrence rates range from 5 % to 33 %. 3 , 7 , 8 , 9 , 10 Recurrence leads to a significant economic burden to the family and society. 11 Several studies have identified predictors for CSDH recurrence, usually with mixed results.…”

“… 11 Several studies have identified predictors for CSDH recurrence, usually with mixed results. 9 , 12 Despite the decreasing mortality after subdural hematoma (SDH), it is still unclear if functional recovery has improved. 4 Additionally, there is limited data regarding risk factors for readmission after SDH evacuation, and there is limited understanding of the differences in predictive factors between SDH types.…”

Biofluid Biomarkers in the Prognosis of Chronic Subdural Hematoma: A Systematic Scoping Review

“…The median (interquartile range, IQR) patient sample size of the included studies was 93 (60-258). The median (IQR) recurrence rate of twenty-one studies (two studies did not provide recurrence data) was 17.5% (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

“…In this context, previous studies have sought to establish the factors associated Diagnostics 2023, 13, 2449 2 of 13 with an increased risk of cSDH recurrence and/or which can aid in the prediction of neurological/functional outcomes. Thus far, several clinical factors, e.g., increased patient age, radiological characteristics, e.g., bilateral hematoma, and specific external membrane features, e.g., enhanced presence of angiogenic factors, have been previously indicated as risk factors for cSDH recurrence [5][6][7][8]. Additional research has focused on identifying prognostic molecular or cellular factors within the hematoma fluid and/or peripheral blood of cSDH patients.…”