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J Neurol Surg A Cent Eur Neurosurg 2025; 86(04): 353-360
DOI: 10.1055/s-0044-1792142
Original Article

Preoperative and Postoperative Midline Index Ratio and Pre- and Postoperative Variation of the Hematoma Thickness Accurately Predict Surgical Recurrence of Chronic Subdural Hematomas

Federica Novegno
1   Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
,
Giulia Fiorucci
1   Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
,
Andrea Iaquinandi 
1   Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
,
Maurizio Salvati
1   Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
,
Alessandro Pesce
1   Division of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
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Funding None.
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Abstract

Background Chronic subdural hematoma (cSDH) is a common pathology in daily practice of neurosurgery. Surgical management usually offers a significant clinical recovery. However, the recurrence rate is still high. Several studies have suggested various factors associated with hematoma recurrence with no univocal results. The aim of this study was to determine the prognostic value of early postoperative computed tomography (CT) examination to predict the need for reoperation.

Methods A retrospective review of 115 cSDH patients was performed. Clinical findings and pre- and early postoperative CT scan data were recorded. Univariable and bivariable analyses were performed to determine which of the studied factors were associated with an increased risk of reoperation. Their prognostic abilities were assessed using receiver operating characteristic curves.

Results Overall, 21 of 115 patients required a surgical revision. Among the comorbidities, diabetes mellitus represented the only factor related with hematoma recurrence (66.76 vs. 23.40%, p = 0.001). Preoperative hematoma density and postoperative residual hyperdensity on early CT scan emerged as significant predictors of cSDH recurrence (recurrence: 18/21, 85.7% vs. nonrecurrence: 17/94, 18.1%, p = 0.001). The ratios of post- and preoperative hematoma thickness (P) and post- and preoperative midline shift (Q) and their sum (K) were statistically higher in the recurrence group with cutoff values of 0.745, 0.555, and 1.135, respectively.

Conclusions Systematic early postoperative CT scan after cSDH evacuation may predict hematoma recurrence. In the present study, we found postoperative hyperdensity on CT scan and degree of hematoma variation after surgical evacuation to be the strongest predictors of the need for reoperation.

Keywords

chronic subdural hematoma - recurrence - computed tomography - surgery

Institutional Review Board Statement

Ethics committee/institutional review board approval is not required for this manuscript because it involves a retrospective observational data collection. The data collected are purely retrospective and devoid of any treatment randomization. Additionally, the radiologic and clinical data analyzed are completely anonymous, with no variations from world-recognized gold standard treatments. This is just an analyzed series of retrospective data concerning radiologic prognosis. Of course, all the included patients signed a formal informed consent after appropriate information for both letting the data to be analyzed in research and concerning surgical information.


Informed Consent Statement

Written informed consent has been obtained from the patients to publish research papers concerning their clinical conditions. The surgical and research informed consent was approved by our institution. The blank copy of the consent is available on request.


Supplementary Material



Publication History

Received: 07 May 2024

Accepted: 17 September 2024

Article published online:
31 December 2024

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