Recurrent Chronic Subdural Hematoma: Clinical and Imaging Risk Factors

Abstract

Background Chronic subdural hematoma (CSDH) is a major cause of neurosurgical emergencies in the elderly. Despite the use of routine surgical practices, recurrence of this condition is expected. This study was conducted to identify the risk factors (RF) for recurrent CSDH.

Methods Between January 2016 and July 2017, 103 consecutive patients suffering from CSDH were admitted to our department. The no-recurrence group (NRG) consisted of 91 patients, and the recurrence group (RG) consisted of 12 patients. To identify the RF involved in recurrent CSDH, we analyzed multiple factors, including patient comorbidities and imaging data.

Results Between the two groups, there were no statistical differences (p > 0.05) for head trauma, diabetes mellitus (DM), high blood pressure, heart diseases, anticoagulation agents, or seizures; however, DM was associated with one of the above-mentioned factors. In contrast, there were significant differences for antiplatelet agents (APA) (p < 10–6) and the right side of the hematoma location (p = 0.03).

Conclusion Although the literature highlights the controversy regarding RF for CSDH, we detected APA and the right side as RF, whereas DM alone or associated with another comorbidity does not affect the CSDH outcome.

Keywords

chronic subdural hematoma - recurrence - risk factor - diabetes mellitus - comorbidity

• References

• 1 Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg 2015; 123 (05) 1209-1215
• 2 Karibe H, Kameyama M, Kawase M, Hirano T, Kawaguchi T, Tominaga T. Epidemiology of chronic subdural hematomas. [in Japanese] No Shinkei Geka 2011; 39 (12) 1149-1153
• 3 Stavrinou P, Katsigiannis S, Lee JH. et al. Risk factors for chronic subdural hematoma recurrence identified using quantitative computed tomography analysis of hematoma volume and density. World Neurosurg 2017; 99: 465-470
• 4 Abdelsadg M, Kanodia AK, Abbas A, Sheikh A. Chronic subdural haematoma: Systematic review highlighting risk factors for recurrent bleeds. Neuro Open J 2017; 4: 16-24
• 5 Soleman J, Nocera F, Mariani L. The conservative and pharmacological management of chronic subdural haematoma. Swiss Med Wkly 2017; 147: w14398
• 6 Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 2008; 63 (06) 1125-1129 discussion 1129
• 7 Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012; 154 (09) 1541-1548
• 8 Fujitani S, Ishikawa O, Miura K, Takeda Y, Goto H, Maeda K. Factors predicting contralateral hematoma growth after unilateral drainage of bilateral chronic subdural hematoma. J Neurosurg 2017; 126 (03) 755-759
• 9 Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ. Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 2017; 127 (05) 1117-1125
• 10 Qian Z, Yang D, Sun F, Sun Z. Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone. Br J Neurosurg 2017; 31 (01) 84-88
• 11 Song DH, Kim YS, Chun HJ. et al. The predicting factors for recurrence of chronic subdural hematoma treated with burr hole and drainage. Korean J Neurotrauma 2014; 10 (02) 41-48
• 12 Suarez JI, Kapinos G. Thromboembolism prevention after chronic subdural hematoma in the elderly: a leap in the dark. Neurology 2017; 88 (20) 1880-1881
• 13 Tokmak M, Iplikcioglu AC, Bek S, Gökduman CA, Erdal M. The role of exudation in chronic subdural hematomas. J Neurosurg 2007; 107 (02) 290-295
• 14 Wada M, Yamakami I, Higuchi Y. et al. Influence of antiplatelet therapy on postoperative recurrence of chronic subdural hematoma: a multicenter retrospective study in 719 patients. Clin Neurol Neurosurg 2014; 120: 49-54
• 15 Yamamoto H, Hirashima Y, Hamada H, Hayashi N, Origasa H, Endo S. Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model. J Neurosurg 2003; 98 (06) 1217-1221
• 16 D'Errico AP, German WJ. Chronic subdural hematoma. Yale J Biol Med 1930; 3 (01) 11-20
• 17 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 2014; 75 (01) 37-41
• 18 Kale A, Öz İİ, Gün EG, Kalaycı M, Gül Ş. Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage?. Neurol Res 2017; 39 (05) 399-402
• 19 Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010; 87 (01) 4-14
• 20 Rust T, Kiemer N, Erasmus A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci 2006; 13 (08) 823-827
• 21 Wang Y, Zhou J, Fan C. et al. Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a meta-analysis. J Clin Neurosci 2017; 38: 79-83
• 22 Huang YH, Yang K-Y, Lee T-C, Liao C-C. Bilateral chronic subdural hematoma: What is the clinical significance?. Int J Surg 2013; 11: 544-548
• 23 Amirjamshidi A, Abouzari M, Eftekhar B. et al. Outcomes and recurrence rates in chronic subdural haematoma. Br J Neurosurg 2007; 21 (03) 272-275
• 24 Oishi M, Toyama M, Tamatani S, Kitazawa T, Saito M. Clinical factors of recurrent chronic subdural hematoma. Neurol Med Chir (Tokyo) 2001; 41 (08) 382-386
• 25 Sundaravadhanan S, Deb P. Chronic subdural hematoma: role of vascular endothelial growth factor and craniotomy in pathophysiology and prevention of recurrence. Indian J Neurotrauma 2017; 14 (01) 1-5