Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis
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REVIEW
Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis Ishita P. Miah 1 & Yeliz Tank 2 & Frits R. Rosendaal 3 & Wilco C. Peul 1,4 & Ruben Dammers 5 & Hester F. Lingsma 6 & Heleen M. den Hertog 7 & Korné Jellema 4 & Niels A. van der Gaag 4,8 & on behalf of the Dutch Chronic Subdural Hematoma Research Group Received: 29 July 2020 / Accepted: 16 September 2020 # The Author(s) 2020
Abstract Purpose Chronic subdural hematoma (CSDH) is associated with high recurrence rates. Radiographic prognostic factors may identify patients who are prone for recurrence and who might benefit further optimization of therapy. In this meta-analysis, we systematically evaluated pre-operative radiological prognostic factors of recurrence after surgery. Methods Electronic databases were searched until September 2020 for relevant publications. Studies reporting on CSDH recurrence in symptomatic CSDH patients with only surgical treatment were included. Random or fixed effects meta-analysis was used depending on statistical heterogeneity. Results Twenty-two studies were identified with a total of 5566 patients (mean age 69 years) with recurrence occurring in 801 patients (14.4%). Hyperdense components (hyperdense homogeneous and mixed density) were the strongest prognostic factor of recurrence (pooled RR 2.83, 95% CI 1.69–4.73). Laminar and separated architecture types also revealed higher recurrence rates (RR 1.37, 95% CI 1.04–1.80 and RR 1.76 95% CI 1.38–2.16, respectively). Hematoma thickness and midline shift above predefined cut-off values (10 mm and 20 mm) were associated with an increased recurrence rate (RR 1.79, 95% CI 1.45–2.21 and RR 1.38, 95% CI 1.11–1.73, respectively). Bilateral CSDH was also associated with an increased recurrence risk (RR 1.34, 95% CI 0.98–1.84). Key points • Recurrence of chronic subdural hematoma (CSDH) after surgery occurs frequently with reported rates that vary between 2.5 and 33%. • Establishment of radiographic prognostic factors may identify more complex patients prone to CSDH recurrence. • Many radiological parameters of CSDH have been reported to be associated with the recurrence risk, with conflicting results due to discrepancies in recurrence rate and study heterogeneity. • In this meta-analysis of 22 studies, we found hyperdense and mixed density hematoma to be associated with the highest risk of CSDH recurrence after surgery, as were laminar and separated hematoma architecture types. • Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures. * Ishita P. Miah [email protected]; [email protected]
Hester F. Lingsma [email protected]
Yeliz Tank [email protected]
Heleen M. den Hertog [email protected]
Frits R. Rosendaal [email protected]
Korné Jellema [email protected]
Wilco C. Peul [email protected] Ruben Dammers [email protected]
Niels A. van der Gaag [email protected] Extended author information available on the last page of the
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