Analysis of Preoperative Imaging Factors and Development of a Nomogram Model for Predicting Recurrence in Patients with Septated Chronic Subdural Hematoma.

Aim: To develop a nomogram model that provides a clinical prediction method for preventing septated chronic subdural hematoma (sCSDH) recurrence after surgery and serves as a reference for selecting surgical approaches.

Material and methods: This study involved 237 patients diagnosed with sCSDH. Based on the recurrence status of the affected side during follow-up, patients were divided into a recurrence group (43 cases) and a non-recurrence group (194 cases). The imaging-related factors influencing the recurrence of sCSDH after surgery were initially screened using univariate analysis, followed by multivariate logistic regression analysis to identify independent risk factors. A nomogram model was developed using R software, and internal validation was conducted using the bootstrap method.

Results: The univariate analysis revealed that cerebral atrophy, bilateral hematomas, preoperative midline shift distance, sCSDH typing, and neovascularization were the significant factors in the postoperative recurrence of sCSDH. However, the multivariate logistic regression analysis identified encephalatrophy, bilateral hematomas, and neovascularization as independent risk factors for sCSDH recurrence. Furthermore, the nomogram model analysis demonstrated good discrimination with an AUC of 0.764 (95% CI: 0.6958-0.8322), while the P-value of the Hosmer-Lemeshow test was 0.4382, indicating good consistency.

Conclusion: Encephalatrophy, bilateral hematomas, and neovascularization are independent imaging risk factors associated with sCSDH recurrence. The developed nomogram model will enable clinicians to assess and identify patients at a higher risk of sCSDH recurrence, enabling them to formulate appropriate diagnostic and treatment strategies.