Chronic subdural hematoma: Clinical experience and recurrence risk factors in a Mexican neurosurgery residency training program.

Surgical neurology international Pub Date : 2025-05-16 eCollection Date: 2025-01-01 DOI:10.25259/SNI_71_2025

Aurelio Ponce-Ayala, José de Jesús Gutiérrez-Baños, Rafael Mendizabal-Guerra, Mauricio Ivan Rodriguez-Pereira, Juan Carrizales-Rodriguez

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Abstract

Background: Chronic subdural hematoma (CSDH) recurrence remains a challenge, with risk factors still debated.

Methods: 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 (P < 0.05).

Results: 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, P = 0.001) and prolonged partial thromboplastin time (>38.6 s, P = 0.005). Craniotomy had lower recurrence (7%) than burr-holes (P = 0.053).

Conclusion: 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.

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慢性硬膜下血肿：墨西哥神经外科住院医师培训项目的临床经验和复发风险因素。

背景：慢性硬膜下血肿（CSDH）复发仍然是一个挑战，危险因素仍然存在争议。方法：回顾性分析Juárez de m xico医院2014-2019年手术治疗的185例CSDH病例。复发定义为临床恶化伴放射学再扩张。统计学、临床、影像学及围手术期各项指标分析均有统计学意义（P < 0.05）。结果：该队列包括145名男性（78.4%），中位年龄55岁。头部外伤占75.7%。血肿多为慢性血肿（69.2%），49.18%血肿密度不均匀。手术入路为单钻孔（4.3%）、双钻孔（10.8%）和开颅（84.9%）。复发16例（8.4%），以1周内复发为主。复发的重要危险因素包括血小板减少（P = 0.001）和部分凝血活酶时间延长（>38.6 s, P = 0.005）。开颅手术的复发率（7%）低于钻孔手术（P = 0.053）。结论：血小板减少和凝血功能障碍增加CSDH复发风险。与钻孔术相比，开颅术可减少复发率。需要进一步的研究来优化手术处理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Surgical neurology international

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