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

Autor: Miah IP; Department of Neurology and Neurosurgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333, ZA, Leiden, The Netherlands. i.p.miah@lumc.nl., Tank Y; Department of Radiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333, ZA, Leiden, The Netherlands., Rosendaal FR; Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333, ZA, Leiden, The Netherlands., Peul WC; Department of Neurology and Neurosurgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), Lijnbaan 32, 2512, VA, The Hague, The Netherlands., Dammers R; Department of Neurosurgery, Erasmus Medical Center (EMC), Erasmus MC Stroke Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands., Lingsma HF; Department of Public Health and Medical Decision Making, Erasmus Medical Center (EMC), Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands., den Hertog HM; Department of Neurology, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands., Jellema K; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), Lijnbaan 32, 2512, VA, The Hague, The Netherlands., van der Gaag NA; Department of Neurology and Neurosurgery, Haaglanden Medical Center (HMC), Lijnbaan 32, 2512, VA, The Hague, The Netherlands.; Department of Neurosurgery, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545, AA, The Hague, The Netherlands.
Jazyk: angličtina
Zdroj: Neuroradiology [Neuroradiology] 2021 Jan; Vol. 63 (1), pp. 27-40. Date of Electronic Publication: 2020 Oct 22.
DOI: 10.1007/s00234-020-02558-x
Abstrakt: 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.
Databáze: MEDLINE
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