What question did this study set out to answer?

This study aims to understand the relationship between the residual volumes of hematoma and recurrence rates of chronic subdural hematoma (CSDH).

March 1, 2026

Postoperative volumetric distribution influence on recurrence of chronic subdural hematoma: A retrospective cohort study

LSLaurie SanterreUniversité Laval NBNoé Emile Belghazi-Saison JFJuliette Fournier-LoiselleUniversité Laval

Key Points

This study aims to understand the relationship between the residual volumes of hematoma and recurrence rates of chronic subdural hematoma (CSDH).
Conducted a retrospective cohort study of patients with CSDH treated via minicraniotomy or burr-hole drainage.
Performed volumetric analysis on pre- and postoperative CT scans using 3D Slicer software.
Utilized univariate and multivariate analyses to assess clinical and radiological factors.
Included 207 patients with a 16.5% recurrence rate (32 recurrences/194 patients).
Significant associations found between recurrence and factors like age, history of anticoagulant/antiplatelet use, and various residual volumes.
Total postoperative residual volume independently predicted recurrence (OR = 2.899 per 10 cc increase, P < 0.001).

Abstract

Background: Chronic subdural hematomas (CSDHs) are a common neurosurgical pathology with a recurrence rate between 6.4% and 28.0%. The influence of volumetric distribution on recurrence is still unclear. This study aims to determine if residual volumes of hematoma, air, and rinsing fluid are significantly associated with CSDH recurrence. Methods: This is a retrospective cohort study on patients diagnosed with CSDH treated with minicraniotomy or burr-hole drainage. Volumetric analysis was conducted on preoperative and postoperative computed tomography imaging using 3D Slicer software. Clinical and radiological factors were analyzed using univariate and multivariate analysis. Recurrence was based on radiological and clinical findings. Results: Two hundred and seven patients were included in the study. Recurrence rate was 16.5% (32 recurrences/194 patients). There were 13 patients lost to follow-up. Age (76 vs. 71 years, P = 0.038), history of anticoagulants use (34.4 vs. 16.7%, P = 0.021), history of antiplatelets use (46.9 vs. 27.2%, P = 0.027), preoperative CSDH volume (44.84 vs. 35.51 cc, P = 0.002), preoperative midline shift (9.88 vs. 8.06 mm, P = 0.027), postoperative residual volumes of hematoma (5.62 vs. 2.22 cc, P < 0.001), rinsing fluid (20.02 vs. 13.77 cc, P < 0.001) and air (9.25 vs. 4.93 cc, P = 0.001), postoperative total residual volume (34.89 vs. 20.92 cc, P < 0.001), and postoperative midline shift (6.49 vs. 4.23 mm, P < 0.001) were all significantly associated with recurrence in the univariate regression analysis. History of anticoagulants use (odds ratio OR = 2.689, 95% confidence interval CI 1.016–7.122, P = 0.046), and postoperative total volume (OR = 2.899/10 cc, 95% CI 1.876–4.479, P < 0.001) were independent factors of CSDH recurrence in the multivariate analysis. Conclusion: This study suggests that CSDH recurrence is most strongly influenced by total postoperative residual volume rather than individual residual volumes. The strong correlation between recurrence and residual rinsing fluid highlights the need to reassess the use of rinsing fluid to reduce residual air as a common practice.

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