Clinical Outcome of Redo-Surgery for Recurrent Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis Combined with a Case Series

Abstract

Objective: Chronic subdural hematoma (CSDH) is becoming more prevalent, particularly in aging populations, with a 20% recurrence rate postsurgery. Burr hole craniostomy is the standard treatment, but recurrence remains a significant challenge. This study evaluates the incidence of second CSDH recurrence, its management, and clinical outcomes following various hematoma evacuation procedures in the literature and our cohort. Methods: A systematic review identified 8 studies with 183 patients. Additionally, we analyzed 63 consecutive patients undergoing reoperation for recurrent CSDH at our center, assessing second recurrence rates, clinical outcomes, and the impact of comorbidities and antithrombotic medication. Results: Meta-analysis showed a pooled second recurrence rate of 20% (95% confidence interval 13%–30%), versus 15.9% in our cohort. Most second recurrences occurred within a month postsurgery. Clinical outcomes were unfavorable, with most patients having residual symptoms and achieving only moderate-to-poor functional recovery (modified Rankin Scale 2–4). Comorbidities such as diabetes did not significantly influence recurrence rates. In contrast to previous reports, the use of antithrombotic medication was associated with a significantly lower recurrence rate in our cohort. Conclusions: Redo-surgery is currently the primary treatment for (subsequent) recurrent CSDH and leads to unfavorable outcomes. Given the high recurrence rates and poor functional recovery, there is a need for improved treatment approaches to address the underlying pathophysiology of CSDH. Further research is needed to evaluate the effectiveness of middle meningeal artery embolization in the context of recurrence and improving clinical outcomes.