Background: While surgical treatment can achieve good outcomes in patients with chronic subdural hematoma (CSDH), recurrence is not rare. Various factors, including patient age, the administration of anticoagulant drugs and the volume of hematoma are associated with the recurrence of CSDH. In the present retrospective study, we analyze predictors of the recurrence of CSDH on pre–operative CT.
Material and Methods: One hundred nine patients with unilateral initial CSDH who were managed between January 2017 and April 2021 were included in the present study. Physical factors including age, sex, diabetes mellitus, antiplatelet or anticoagulant therapy and pre–operative CT findings, including side of hematoma, properties of hematoma (homogeneous, laminar, separated, trabecular), midline shift value and maximal width of hematoma were analyzed in patients with symptomatic recurrence (recurrent group) and patients without recurrence (non–recurrent group). Symptomatic recurrence was defined as by the presence of neurological deterioration with hematoma re–accumulation on CT.
Results: Twenty–eight of 109 patients (25.7%) had symptomatic recurrence of CSDH. There were no significant differences in the physical factors of the patients in the recurrent and non–recurrent groups. In a multivariate analysis, significant differences were observed in the separated type hematoma and the midline shift values on pre–operative CT between the recurrent and non–recurrent groups. The receiver operating characteristic curve between symptomatic recurrence and the midline shift value demonstrated a cut–off value of 6.6 mm (AUC, 0.67; sensitivity, 0.71; specificity, 0.58).
Conclusions: The separated type hematoma and the value of midline shift on pre–operative CT were independent predictors of symptomatic recurrence of CSDH. If the midline shift value on pre–operative CT is >6.6 mm, the risk of symptomatic recurrence was high.
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