Factors Predicting Recurrence in Chronic Subdural Hematoma

Background: Chronic subdural hematoma (CSDH) is a common daily practice in neurosurgery with significant recurrence rate. Objectives: To prove that computerized tomography (CT) is the most important diagnostic tool and burr hole irrigation is the most common treatment modality. Patients and Methods: Forty-six adult surgical CSDH cases in Ain Shams University Hospitals treated with burr hole irrigation were retrospectively investigated to correlate between CSDH recurrence and personal, pre-and post-operative clinical and radiographic characteristics. Results: In this study, twelve cases out of forty-six surgical CSDH patients experienced recurrence. Potential risk factors of CSDH recurrence were bleeding tendency (P value= 0.047), old age (P value=0.0423) and large volume (p value=0.0434). Radiological risk factors included CSDH mixeddensity (inhomogenous=fresh and chronic blood components) (p value=0.046) on pre-operative CT scan and air collection (Pneumocephalus) on the first post-operative follow up CT scan (p value=0.04). Conclusion: Bleeding tendency might facilitate CSDH recurrence. CSDH large volume and old age were found in our study to be associated with recurrence. Radiological potential risk factors of CSDH recurrence might include mixed density (inhomogenous = fresh and chronic blood components) and post-operative air collection (Pneumocephalus).