Chronic Subdural Hematoma Prognostic Factors for Recurrence

Abstract
Background: Chronic Subdural Hematoma (CSDH) is a common neurologic disease in elderly. It is not always a benign condition because high recurrence rate had been reported. Independent risk factors for CSDH recurrence, especially the surgical and post-operative factors, had not been sufficiently investigated.
Aim of Study: To evaluate the outcome of CSDH after burr hole craniostomy and irrigation with closed system drainage, and to analyze the potential risk factors, emphasizing surgical and post-operative ones, for CSDH recurrence and comparing the results to others mentioned in literature.
Methods: We retrospectively analysed data of 82 CSDH patients treated by burr hole(s) craniostomy and irrigation with close system drainage CSDH in Assuit University Hospital from July 2015 to July 2016.
Results: Of these CSDH patients, the main age was 58.9 years and 85.4% were males. The CSDH recurrence rate after burr-hole craniostomy was 7.3% in our hospital. CSDH recurrence was significantly associated with diabetes mellitus (p=0.027), hypertension (p=0.021) and prolonged PT (p= 0.025). Moreover an increased CSDH recurrence rate was observed in the patient group that had a mixed type (p=0.047), separated (p=0.044), trabecular (p=0.025) and hematoma thickness more than 20mm (p=0.34) of the CSDH in the preoperative diagnostic imaging .Also there were increased recurrence rate in patients group that had postoperative residual hematoma (p<0.001).
Conclusion: We found diabetes mellitus, hypertension, prolonged PT, mixed type hematoma, separated, trabecular internal architecture of hematoma, thickness of hematoma 20mm and post-operative residual hematoma independently predict recurrence of CSDH after burr hole(s) craniostomy. The patients with these risk factors may need closer surveil-lance post-operatively.