Ponce-Ayala Aurelio, Gutiérrez-Baños José de Jesús, Mendizabal-Guerra Rafael, Rodriguez-Pereira Mauricio Ivan, Carrizales-Rodriguez Juan
Department of Neurosurgery and Spine Surgery, Centennial Hospital, Miguel Hidalgo, Aguascalientes, Mexico.
Department of Endovascular Neurosurgery, October 1st Regional Hospital, ISSSTE, Mexico City, Mexico.
Surg Neurol Int. 2025 May 16;16:181. doi: 10.25259/SNI_71_2025. eCollection 2025.
Chronic subdural hematoma (CSDH) recurrence remains a challenge, with risk factors still debated.
A retrospective review of 185 CSDH cases surgically treated at Hospital Juárez de México (2014-2019) was conducted. Recurrence was defined as clinical deterioration with radiological re-expansion. Demographic, clinical, imaging and perioperative variables were analyzed statistically ( < 0.05).
The cohort included 145 males (78.4%) median age of 55 years. Head trauma was present in 75.7%. Hematomas were mostly chronic (69.2%), with 49.18% showing heterogeneous density. The surgical approaches used were single burr-hole (4.3%), double burr-hole (10.8%), and craniotomy (84.9%). Recurrence occurred in 16 cases (8.4%), primarily within a week. The significant risk factors for recurrence included thrombocytopenia (<130,000/uL, = 0.001) and prolonged partial thromboplastin time (>38.6 s, = 0.005). Craniotomy had lower recurrence (7%) than burr-holes ( = 0.053).
Thrombocytopenia and coagulopathy increase recurrence risk in CSDH. Craniotomy may reduce recurrence compared to burr-hole techniques. Further studies are needed to optimize surgical management.
慢性硬膜下血肿（CSDH）复发仍是一个挑战，其危险因素仍存在争议。
对墨西哥华雷斯医院（2014 - 2019年）手术治疗的185例CSDH病例进行回顾性研究。复发定义为临床病情恶化且影像学显示血肿再次扩大。对人口统计学、临床、影像学和围手术期变量进行统计学分析（<0.05）。
该队列包括145名男性（78.4%），中位年龄55岁。75.7%的患者有头部外伤史。血肿大多为慢性（69.2%），49.18%表现为密度不均。采用的手术方法包括单钻孔（4.3%）、双钻孔（10.8%）和开颅手术（84.9%）。16例（8.4%）出现复发，主要在一周内。复发的显著危险因素包括血小板减少症（<130,000/μL， = 0.001）和活化部分凝血活酶时间延长（>38.6秒， = 0.005）。开颅手术的复发率（7%）低于钻孔手术（ = 0.053）。
血小板减少症和凝血功能障碍会增加CSDH的复发风险。与钻孔技术相比，开颅手术可能会降低复发率。需要进一步研究以优化手术管理。
