Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-Ro 170Beon-Gil, Dongan-Gu, Anyang-Si, Gyeonggi-Do, 14068, Republic of Korea.
Neurosurg Rev. 2023 Nov 20;46(1):306. doi: 10.1007/s10143-023-02222-x.
Chronic subdural hematoma (SDH) is a common disease in the neurosurgical field, and hematoma drainage through burr hole trephination has been widely considered the optimal treatment for SDH. Despite numerous investigations aimed at predicting recurrence rates and associated factors, studies have demonstrated inconsistent results. In this study, we aimed to comprehensively determine the predictive factors of chronic SDH recurrence in surgically treated patients. We retrospectively evaluated 578 consecutive patients who underwent single burr hole surgery for chronic SDH at our institute between January 2008 and December 2021. Various clinical and radiological factors in patients with and without recurrence were compared using univariate and multivariate logistic regression analyses. A total of 438 patients (531 hemispheres) were analyzed. Fifty-four (10.17%) of the 531 hemispheres had recurrence of chronic SDH within 6 months. Male sex (adjusted odds ratio (aOR) = 3.48; 95% confidence interval (CI), 1.42-8.49), bilateral hematomas (aOR = 2.14; 95% CI, 1.05-4.35), laminar hematoma type (aOR = 2.87; 95% CI, 1.23-6.71), > 30-cm volume of postoperative residual hematoma (aOR = 2.99; 95% CI, 1.01-8.83), and preoperative blood glucose level of ≥ 150 mg/dL (aOR = 2.11; 95% CI, 1.10-4.05) were identified as independent factors associated with recurrence in multivariate logistic regression analysis. The present study revealed that male patients and those who had bilateral hematomas, laminar hematoma type, a large volume of hematoma after surgery, and a high preoperative blood glucose level had a higher probability of experiencing recurrent chronic SDH. We recommend close monitoring of patients 6 months postoperatively to detect subsequent chronic SDH recurrence.
慢性硬脑膜下血肿（SDH）是神经外科领域的常见疾病，通过颅骨钻孔引流已被广泛认为是治疗 SDH 的最佳方法。尽管有许多旨在预测复发率和相关因素的研究，但研究结果并不一致。在本研究中，我们旨在全面确定手术治疗的慢性 SDH 患者复发的预测因素。我们回顾性评估了 2008 年 1 月至 2021 年 12 月在我院接受单一颅骨钻孔手术治疗的 578 例连续慢性 SDH 患者。使用单变量和多变量逻辑回归分析比较了有和无复发患者的各种临床和影像学因素。共分析了 438 例患者（531 侧）。531 侧中有 54 侧（10.17%）在 6 个月内出现慢性 SDH 复发。男性（校正优势比（aOR）=3.48；95%置信区间（CI），1.42-8.49）、双侧血肿（aOR=2.14；95%CI，1.05-4.35）、层状血肿类型（aOR=2.87；95%CI，1.23-6.71）、术后残余血肿体积＞30cm³（aOR=2.99；95%CI，1.01-8.83）和术前血糖水平≥150mg/dL（aOR=2.11；95%CI，1.10-4.05）在多变量逻辑回归分析中被确定为与复发相关的独立因素。本研究表明，男性患者和双侧血肿、层状血肿类型、术后血肿量大、术前血糖水平高的患者发生复发性慢性 SDH 的可能性更高。我们建议术后 6 个月密切监测患者，以发现随后的慢性 SDH 复发。
