Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis.
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).


LIMITATIONS
Limitations were no adjustments for confounders and variable data heterogeneity. Clinical factors could also be predictive of recurrence but are beyond the scope of this study.


CONCLUSIONS
Hyperdense hematoma components were the strongest prognostic factor of recurrence after surgery. Awareness of these findings allows for individual risk assessment and might prompt clinicians to tailor treatment measures.
['Miah|Ishita P|IP|http://orcid.org/0000-0003-4676-7955', 'Tank|Yeliz|Y|', 'Rosendaal|Frits R|FR|', 'Peul|Wilco C|WC|', 'Dammers|Ruben|R|', 'Lingsma|Hester F|HF|', 'den Hertog|Heleen M|HM|', 'Jellema|Korné|K|', 'van der Gaag|Niels A|NA|', '|||']
D000368:Aged D020200:Hematoma, Subdural, Chronic D006801:Humans D011379:Prognosis D011859:Radiography D012008:Recurrence D018570:Risk Assessment
Chronic subdural hematoma Recurrence CSDH CT Predictors