gms | German Medical Science

Objective: Chronic subdural hematoma (cSDH) is a common disease which is increasing due to aging population and the use of anticoagulation and antiplatelet medication. Aim of this study is to investigate new risk factors for recurrent cSDH after surgery and for developing cSDH in first place. Furthermore, was the aim to analyze the internal structure of cSDH using cranial CT-imaging and to investigate potential associations between the type of cSDH and the recurrence rate. The aim is to better understand the disease patterns and to maximize treatment options.

Methods: This retrospective study evaluated data of 189 patients that were treated surgical between 2014-2018 at our department. Recorded were demographic-, clinical-, surgical treatment-, cCT-imaging-, neurological status- and follow up data. The outcome was assessed clinically and with follow-up cCT imaging 3-4 weeks after surgery. Coronar-cCT images were used to measure the thickness of haematomas, hyperdens areas, chronic parts and membranes. Complications and outcome was defined using modified Ranking scale (mRS) 4 weeks after the treatment.

Results: After surgical treatment patients showed a significantly higher BMI (p<0,001, 61,6%), arterial hypertension (p<0,001, 68,3%) and the intake of anticoagulant therapy (p<0,001, 58%). The patients were initially symptomatic in 48,6 % with a paresis, in 33,7 % with an aphasia and in 41,6% with a dizziness. In 35 cases was a recurrent cSDH found after 3-4 weeks. The frontoparietal convexity-typ was in 70 % the most represented. In 60 % the internal structure of cSDH was septated, 66,7% had an architectural change of the hematoma. After univariable and multivariable analysis, the initial hemispheric typ (p=0,019, HR: 3,191; p=0,012, HR: 3,810) and the increasing preoperative midline shift (p=0,028, HR: 1,114; p=0,041, HR: 1,107) in CT-imaging increase are independent predictors for recurrence. In 5,8 % was a revision surgery due to recurrence cSDH necessary. Complications were found in 6,3 % with secondary hemorrhage and 1,6 % wound healing deficit. 70,3 % of the patients with recurrence cSDH had a mRS of 0-2.

Conclusion: Increasing midline shift before surgery as well as hemispheric typ of haematoma were independent predictors for recurrence according to our data. The most of patients achieved an excellent outcome with low risk profile.