Factors Causing for Recurrence of Chronic Sub Dural Hematoma after Burr Hole Craniotomy and Evacuation

Abstract

Objective: To determine the incidence of recurrence of Chronic Sub Dural Hematoma (CSDH) and its associated factors at a tertiary care Hospital.

Methodology: This cross-sectional observational study was conducted at Neurosurgery department at Pakistan Institute of Medical Sciences (PIMS), Islamabad, from February 2024 to October 2024. Patients aged 18 years and above, both genders, underwent diagnosed with CSDH confirmed by imaging (CT or MRI) and drained with burr hole craniotomy and evacuation were included. All patients undergoing burr hole craniotomy and evacuation for the drainage of chronic subdural hematoma (CSDH), (a neurosurgical technique involves creating two or more burr holes in the cranium, through which the dura mater is carefully elevated to access the subdural space. Following this, all the patients were followed during the post-operative period till discharge for recurrent CSDH. All the demographic information, including recurrences and risk factors was entered and analyzed using SPSS version 26.

Results: The study included 145 patients, with an overall mean age of 62.59 years, the majority being male (83.4%). The primary underlying cause was trauma, affecting 69.7% of the patients. The overall recurrence rate of hematoma was 12.4%, with approximately half of the cases occurring within two weeks postoperatively. Male gender was a significant risk factor, with 12 of 18 recurrent cases occurring in males compared to 6 in females (p = 0.041). Bilateral hematomas were also significantly associated with recurrence, as 6 of 7 patients with bilateral involvement experienced recurrence (p = 0.001). Hematoma thickness and midline shift were statistically significant predictors, as all 18 recurrent cases had a thickness >15 mm and a midline shift >10 mm (p = 0.001). Regarding drain tube management, 13 of 18 patients whose drains were removed within 24 hours experienced recurrence.

Conclusion: Recurrences of chronic subdural hematoma observed to be the 12.40%. Male gender, bilateral hematoma, mixed density hematoma, thickness and midline shift were found to be the causative factors for recurrences.