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
