Analysis of risk factors for recurrence in septated chronic subdural hematoma

BACKGROUND: Septated chronic subdural hematoma (sCSDH), characterized by its multiseptated or multilayered appearance, poses unique therapeutic challenges due to its considerable recurrence rate. This study aimed to estimate the recurrence rate of sCSDH and identify independent risk factors associated with its recurrence. METHODS: We retrospectively analyzed clinical data from consecutive patients with sCSDH who underwent surgical therapy at our institution. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for sCSDH recurrence. RESULTS: A total of 137 patients with sCSDH underwent surgical treatment, of whom 32 (23.4%) experienced postoperative recurrence. Univariate analysis demonstrated significant associations between sCSDH recurrence and hematoma density (p < 0.001), separation types (p < 0.001), surgical technique (p = 0.002), and resilience of midline shift at the third postoperative day (p = 0.005). Multivariate logistic regression analysis revealed that hybrid hyper dense and isodense hematomas (p = 0.012, OR = 18.74), multiple septations (p = 0.035, OR = 5.93), and honeycomb septations (p = 0.014, OR = 6.45) were independent risk factors for sCSDH recurrence. Endoscopic-assisted surgery significantly reduced recurrence risk compared to single burr hole drainage (OR = 0.256, p = 0.021), indicating that single burr hole drainage serves as an independent risk factor for recurrence. Notably, endoscopic-assisted surgery demonstrated comparable efficacy to craniotomy. However, after adjusting for confounding factors, no significant correlation was observed between midline shift resilience and recurrence rates (OR = 0.958, p = 0.020). CONCLUSION: Hybrid hyper dense and isodense hematomas, honeycomb septations, and single burr hole drainage were identified as independent predictors for sCSDH recurrence.