Can Recurrence of Chronic Subdural Hematoma Be Predicted?

Having read with interest the recent article by Tugcu et al, “Can Recurrence of Chronic Subdural Hematoma Be Predicted? A Retrospective Analysis of 292 Cases,”[1] we would like to make a few observations based on our clinical experience.[2]

First, we note that the average age of the patients treated is relatively low (61 years). In the series published in recent years, the average age was > 75 years.[3] [4] The authors should indicate how many pediatric patients (< 16 years of age) were included in the study because pediatric chronic subdural hematoma (CSDH) cases differ from adult cases, leading to a bias. Second, with 28.1 %, the percentage of bilateral CSDHs is high when compared with other series published in recent years and may be accounted for by pediatric cases as mentioned. Although the authors suggest that “in our series, 28.1% of all operated cases were bilateral, consistent with the literature,” in the latest comprehensive publications, the percentage of bilateral CSDHs only ranges from 7.5 to 20%.[4] [5] [6]

We agree with the authors that treatment with anticoagulants or antiaggregants does not imply a greater risk of recurrence if patients are correctly treated before surgery for blood clotting normalization (especially the international normalized ratio). Finally, we recognize with the authors the need for prospective studies to confirm definitively what factors and what measures affect the recurrence of CSDH.

• References

• 1 Tugcu B, Tanriverdi O, Baydin S , et al. Can recurrence of chronic subdural hematoma be predicted? A retrospective analysis of 292 cases. J Neurol Surg A Cent Eur Neurosurg 2013; ; January 10 (Epub ahead of print)
• 2 Gelabert M, Lopez E, Fernandez JM. Chronic subdural hematoma treated by burr holes and closed drainage system: a review of 630 cases. Med Princ Pract 2001; 10: 41-47
• 3 Miranda LB, Braxton E, Hobbs J, Quigley MR. Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 2011; 114 (1) 72-76
• 4 Santarius T, Kirkpatrick PJ, Ganesan D , et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009; 374 (9695) 1067-1073
• 5 Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005; 107 (3) 223-229
• 6 Kaliaperumal C, Khalil A, Fenton E , et al. A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma. Acta Neurochir (Wien) 2012; 154 (11) 2083-2088 ; discussion 2088–2089