Neurosurg Rev. 2025 Nov 22;49(1):23. doi: 10.1007/s10143-025-03920-4.
ABSTRACT
Chronic subdural hematoma (cSDH) is the most common form of intracranial hemorrhage, with increasing incidence in older population. Despite surgical interventions, recurrence rates remain high, varying between 5 and 37%. Identifying predictors of recurrence, particularly preoperative volumetric thresholds, could change treatment strategies such as middle meningeal artery (MMA) embolization. In this study, 104 patients undergoing burr-hole craniotomy were analyzed. Patients with bilateral hematomas or insufficient radiological data were excluded. Hematoma volume was assessed preoperatively and during follow-up, with recurrence defined as requiring reoperation. While no significant gender differences were found in recurrence rates or hematoma characteristics, preoperative hematoma volume (p = 0.024) and follow-up volume (p < 0.001) were significantly associated with recurrence. Using ROC analysis, a cutoff preoperative volume of 112 mL for females and 130 mL for males was identified, predicting recurrence with high specificity (88.9% in females, 87.5% in males). These findings highlight the importance of volumetric assessment in predicting cSDH recurrence. Integrating these thresholds into clinical decision-making may guide the use of adjunctive therapies, such as MMA embolization, in high-risk patients.
PMID:41273431 | DOI:10.1007/s10143-025-03920-4