Management of chronic subdural hematoma – retrospective single-center study | Daniel Lehner
Management of Chronic Subdural Hematoma
Authors: Daniel Lehner (1), David Cenek (1)
Supervisor: Jan Mraček (1)
(1) Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University and University
Hospital, Pilsen
State-of-the-Art: Chronic subdural hematoma (CSDH) is one of the most common neurosurgi
cal diagnoses in the elderly population, with incidence increasing due to population aging and
widespread use of antithrombotic therapy. Burr-hole evacuation with subdural drainage rep
resents the current standard of surgical treatment. However, recurrence rates reported in the
literature vary between 5–30%. Several perioperative factors have been suggested to influence
recurrence and complications, including the experience of the surgeon, operative time, subdur
al drainage, corticosteroid therapy, and antithrombotic medication. The role of these factors
remains debated in current literature
Objective: To retrospectively analyze patients operated for chronic subdural hematoma and
evaluate whether recurrence correlates with surgeon experience, operative time, subdural
drainage, corticosteroid therapy, and antithrombotic treatment, and whether these factors in
fluence postoperative complications.
Material and Methods: A retrospective single-center study included 100 consecutive patients
surgically treated for chronic subdural hematoma at the Department of Neurosurgery, Univer
sity Hospital Pilsen, from November 2023 to September 2025. Evaluated parameters included
recurrence requiring reoperation, perioperative complications, operative time, surgeon expe
rience, use of corticosteroids, subdural drainage, and antithrombotic therapy. Functional out
come at discharge was assessed using the Glasgow Outcome Scale Extended (GOS-E). Statistical
analysis included descriptive statistics and appropriate non-parametric tests for group compar
isons, with a significance level of p < 0.05.
Results & Discussion: The cohort included 100 patients with a mean age of 73.7 years; 80%
were male. Recurrence occurred in 3 patients (3%) and postoperative complications in 2 patients
(2%). Functional outcome at discharge was excellent with median GOS-E of 8. No statistically
significant association was found between recurrence and surgeon experience (p = 0.244), cor
ticosteroid therapy (p = 1.000), or antithrombotic therapy (p = 0.500). Similarly, complications
were not associated with surgeon experience or corticosteroid therapy. Operative time showed
a non-significant trend toward association with recurrence (p = 0.074). A statistically significant
difference in operative time was observed between surgeon experience levels (Kruskal-Wallis
p = 0.00037).
Conclusion: Treatment of chronic subdural hematoma in our cohort was associated with low re
currence and complication rates and excellent functional outcome. However, due to the limited
cohort size and low number of events, the statistical power of the analysis was limited