Volume and densities of chronic subdural haematoma obtained from CT imaging as predictors of postoperative recurrence: a prospective study of 107 operated patients

Abstract

BackgroundChronic subdural haematoma (CSDH) is a common entity in neurosurgery with a considerable postoperative recurrence rate. Computerised tomography (CT) scanning remains the most important diagnostic test for this disorder. The aim of this study was to characterise the relationship between the recurrence of CSDH after treatment with burr-hole irrigation and closed-system drainage technique and CT scan features of these lesions to assess whether CT findings can be used to predict recurrence.MethodsWe investigated preoperative and postoperative CT scan features and recurrence rate of 107 consecutive adult surgical cases of CSDH and assessed any relationship with univariate and multivariate regression analyses.ResultsSeventeen patients (15.9 %) experienced recurrence of CSDH. The preoperative haematoma volume, the isodense, hyperdense, laminar and separated CT densities and the residual total haematoma cavity volume on the 1st postoperative day after removal of the drainage were identified as radiological predictors of recurrence. If the preoperative haematoma volume was under 115 ml and the residual total haematoma cavity volume postoperatively was under 80 ml, the probability of no recurrence was very high (94.4 % and 97.4 % respectively).ConclusionsThese findings from CT imaging may help to identify patients at risk for postoperative recurrence.

Predictors of functional outcomes and recurrence of chronic subdural hematomas

“…With a postoperative thickness greater than 14 mm, the risk of a poor recovery was increased four-fold. Stanisic et al reported similar results concerning recovery and recurrence [28]. In our series, the homogeneity of the CSH on the preoperative CT scan, side, bilateral or unilateral, and surgical technique, were not associated with a significantly different functional outcome.…”

“…In our study, CSH homogeneity on the preoperative CT scan was not associated with a lower rate of recurrence, in contradiction to other studies [8,28]. A radiographic classification has been described in the literature, in order to assess the evolution of the CSH [20].…”

“…Chon et al also reported that midline deviation on the postoperative CT scan was associated with a more significant risk of recurrence [8]. Stanisic et al reported that midline displacement was not significantly increased at the time of diagnosis of recurrence, in comparison to the first postoperative CT scan [28]. This finding confirms the importance of the early postoperative CT scan.…”

Seizures in Subdural Hematoma

“…Chronic SDH may recur in 6-24 % [38,43]. Recurrence is more likely to happen in patients with preoperative hematoma volume greater than 115 mL and postoperative residual hematoma volume greater than 80 mL, postoperative midline shift greater than 5 mm, preoperative seizures, and in patients on anticoagulant therapy [38,[44][45][46]. In addition, patients with diabetes mellitus, multilocular hematoma, and massive postoperative subdural air are at an increased risk of SDH recurrence.…”

Burr hole is not burr hole: technical considerations to the evacuation of chronic subdural hematomas

“…The open variant should be chosen only if irrigation is desired: the dura and external membrane are opened widely so that the fluid of the hematoma and irrigation can drip out beside the drain during rinsing. Removal of the fluid enriched with inflammatory mediators is considered obviously as an advantage, although a remaining pneumocephalus is seen as an approved factor of recurrence [5,6]. Thus, we prefer the closed way: the aim is that no air enters the subdural space.…”