Chronic Subdural Hematoma in a Tertiary Centre: incidence, etiology, risk-factors, clinical features, management, outcome and outcome predictors

Hematoma Subdural Crônico em um Centro Terciário: incidência, etiologia, fatores de risco, características clínicas, gerenciamento, desfecho e predição de desfecho

• Olukorede Olabanji Adekunle    
• Nurudeen Abiola Adeleke    
• Olakunle Michael Adegboye    
• Oghenevwoke Isaiah Enaworu    
• Hakeem Ayinde Yeqeen    
• Akingbade Adebayo Akin-Dosumu    
• Gbenga Timothy Oyegbami    
• Oluwafemi Nehemiah Akeredolu    
• Nnara Onyeka Stanley    
• Olugbenga Timothy Odebode    

• https://doi.org/10.22290/jbnc.2026.02031018
• J Bras Neurocirur 37 (2):184-191, 2026

Resumo

Introdução: O hematoma subdural crônico (HSDC) permanece uma condição comum em neurocirurgia, com apresentações clínicas variadas. A história de trauma é obtida na maioria dos casos, mas o diagnóstico é confirmado por neuroimagem. Objetivo: Avaliar a epidemiologia, fatores de risco, apresentação, tratamento e desfecho em pacientes manuseados para HSDC. Métodos: Um estudo prospetivo de pacientes manuseados para HSDC durante quatro anos foi conduzido. Os achados clínicos, radiológicos e intraoperatórios foram documentados. Os pacientes foram acompanhados por 3 meses e o desfecho foi avaliado usando a Escala de Desfecho de Glasgow. Resultados: Quarenta e cinco pacientes foram recrutados. Trinta e sete (82.2%) eram do sexo masculino; a maioria dos pacientes estava entre a 5ª e a 8ª décadas de vida. Quarenta pacientes (88.9%) tiveram trauma prévio, enquanto outros (11.1%) foram espontâneos. A queixa mais comum foi cefaleia (39/45; 86.7%). A maioria dos pacientes apresentava grau 1 ou 2 na escala de Markwalder (36/45; 80.0%). Quarenta e três (95.6%) pacientes tiveram drenagem por trepanação. O volume médio de hematoma intraoperatório foi de 81.74 ± 38,01ml; este volume foi maior em mulheres (88.75± 33.99ml) do que em homens (80.14± 39.15ml) (p=0.570). Oito (17.8%) pacientes tiveram recorrência. O desfecho foi favorável em 40 (88.9%) e desfavorável em 5 (11.1%) pacientes. Em uma curva característica de operação do receptor, a idade teve uma área sob a curva de 0.803 (p=0.029) e foi um preditor mais confiável de um desfecho desfavorável. Conclusão: O HSDC permanece comum na prática neurocirúrgica, com preponderância masculina. O trauma é a etiologia modal, enquanto a cefaleia é o sintoma clínico predominante. A drenagem por trepanação ainda é o tratamento de escolha. O desfecho é maioritariamente favorável, mas o aumento da idade pode ser preditivo de um desfecho desfavorável.

Palavras-chave

Hematoma subdural crônico; Estudo prospectivo; Escala de Resultados de Glasgow

Abstract

Introduction: chronic subdural hematoma (CSDH) remains a common condition in neurosurgery with varying clinical presentations. A history of trauma is obtained in most cases, but diagnosis is confirmed by neuroimaging. Objective: to evaluate the epidemiology, risk factors, presentation, treatment and outcome in patients managed for CSDH. Methods: a prospective study of patients managed for CSDH over four years was conducted. Clinical, radiological and intra-operative findings were documented. Patients were followed-up for 3 months and outcome was assessed using the Glasgow Outcome Scale. Results: forty-five patients were recruited. Thirty-seven (82.2%) were males; most patients were between the 5th and 8th decades of life. Forty patients (88.9%) had prior trauma while others (11.1%) were spontaneous. The commonest complaint was headache (39/45; 86.7%). Most patients were either markwalder grade 1 or 2 (36/45; 80.0%). Forty-three (95.6%) patients had burr-hole drainage. The mean intraoperative hematoma volume was 81.74 ± 38.01ml; this was higher in females 88.75± 33.99ml compared to males 80.14± 39.15 mls (p=0.570). Eight (17.8%) patients had recurrence. Outcome was favorable in 40 ( 88.9%) and unfavorable in 5 (11.1%) patients. On a receivers operating characteristic (roc) curve, age had an area under the curve (AUC) of 0.803 (p=0.029) and was a more reliable predictor of an unfavorable outcome. Conclusion: CSDH remains common in neurosurgical practice with a male preponderance. Trauma is the modal etiology while headache is the predominant clinical symptom. Burr-hole drainage is still treatment of choice. Outcome is mostly favorable, but increasing age may be predictive of an unfavorable outcome.

Keywords

Chronic subdural hematoma; Prospective study; Glasgow Outcome Scale

References

1. Debois V. Chronic subdural hematoma. Tijdschr Geneeskd. 1979;35(9):613-9.

2. Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: Inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14(1):180. http://doi.org/10.1186/s12974017-0881-y. PMid:28558815.

3. Mehmandoost M, Bahri A, Hasheminejad A, Sharifi H, Oveisi S, Fahim F. Prevalence, etiology, risk factors, management options, and outcomes in chronic subdural hematoma (cSDH): a comprehensive literature review of recent advances. Brain Disord. 2025;19(8):1-11. http://doi.org/10.1016/j.dscb.2025.100271.

4. Peters DR, Parish J, Monk S, et al. Surgical treatment for chronic subdural hematoma in the elderly: a retrospective analysis. World Neurosurg X. 2023;18(8):100183. http://doi.org/10.1016/j.wnsx.2023.100183. PMid:37013106.

5. Nouri A, Gondar R, Schaller K, Meling T. Chronic Subdural Hematoma (cSDH): a review of the current state of the art. Brain and Spine. 2021;1:100300. http://doi.org/10.1016/j.bas.2021.100300. PMid:36247395.

6. Choi J, Pyen J, Cho S, Kim J, Koo Y, Whang K. Influence of antithrombotic medication on the risk of chronic subdural hematoma recurrence after burr-hole surgery. J Korean Neurosurg Soc. 2020;63(4):513-8. http://doi.org/10.3340/jkns.2019.0194. PMid:32455519.

7. Yang W, Huang J. Chronic subdural hematoma: epidemiology and natural history. Neurosurg Clin N Am. 2017;28(2):205-10. http:// doi.org/10.1016/j.nec.2016.11.002. PMid:28325454.

8. Iliescu IA, Constantinescu AI. Clinical evolutional aspects of chronic subdural haematomas: literature review. J Med Life. 2015;8(Spec Issue):26-33. PMid:26361507.

9. Quiñones-Ossa GA, Maurya VP, Deivasigamani B, et al. Management of chronic subdural hematoma a challenge in neurosurgical practice. J Neurointensive Care. 2023;6(2):69-78. http://doi.org/10.32587/ jnic.2023.00584.

10. Lee KS. How to treat chronic subdural hematoma? Past and now. J Korean Neurosurg Soc. 2019;62(2):144-52. http://doi.org/10.3340/ jkns.2018.0156. PMid:30486622.

11. Májovský M, Netuka D, Beneš V, Kučera P. Burr-hole evacuation of chronic subdural hematoma: biophysically and evidence-based technique improvement. J Neurosci Rural Pract. 2019;10(1):113-8. http://doi.org/10.4103/jnrp.jnrp_167_18. PMid:30765981.

12. Cheon TM, Kim KM, Bae JW, Shim YS, Hyun D-K. Functional outcomes of surgically treated chronic subdural hematoma and the factors associated with outcomes: a retrospective study. J Korean Soc Geriatr Neurosurg. 2023;19(2):39-44. http://doi.org/10.51638/ jksgn.2023.00073.

13. Solou M, Ydreos I, Gavra M, et al. Controversies in the surgical treatment of chronic subdural hematoma: a systematic scoping review. Diagnostics (Basel). 2022;12(9):1-23. http://doi.org/10.3390/ diagnostics12092060. PMid:36140462.

14. Jimoh A, Guga D, Sale D, Mesi M. Chronic subdural haematoma in Zaria. Orient J Med. 2015;27(3–4):109-14.

15. Bankole F, Yusuf A, Kanu O, Ukponmwan E, Nnadi M, Arigbabu SO. Chronic subdural haematoma: clinical presentation, surgical treatment and outcome at the lagos university teaching hospital. Afr J Neurol Sci. 2011;30(1):30.

16. Sioutas GS, Sweid A, Chen CJ, et al. Surgical evacuation for chronic subdural hematoma: predictors of reoperation and functional outcomes. World Neurosurg X. 2023;21(11):100246. http:// doi.org/10.1016/j.wnsx.2023.100246. PMid:38054079.

17. Ou Y, Fan W, Yu X, Wu L, Liu W. A single-center analysis of sex differences in patients with chronic subdural hematoma in China. Front Neurol. 2022;13(5):888526. http://doi.org/10.3389/fneur.2022.888526. PMid:35655622.

18. Oh J-S, Shim J-J, Yoon S-M, Lee K-S. Influence of gender on occurrence of chronic subdural hematoma; is it an effect of cranial asymmetry? Korean J Neurotrauma. 2014;10(2):82-5. http:// doi.org/10.13004/kjnt.2014.10.2.82. PMid:27169039.

19. Morgan E, Adetunmbi B, Ofuadarho C, Poluyi E. A review of the management of chronic subdura haematoma. Trop J Med Dent Pract. 2020;1(1):45-52. http://doi.org/10.47227/tjmdp/v1i1.7.

20. Adetunmbi B, Adebayo B, Bankole O, Adeyomoye A, Morgan E, Kanu O. Chronic subdural hematoma: predicting postoperative recurrence using a correlation of computerized tomographic volume with intraoperative volume. J West Afr Coll Surg. 2023;13(4):40-5.

http://doi.org/10.4103/jwas.jwas_37_23. PMid:38449559.

21. Sambasivan M. An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol. 1997;47(5):418-22. http:// doi.org/10.1016/S0090-3019(97)00188-2. PMid:9131021.

22. Lee JJ, Won Y, Yang T, Kim S, Choi C, Yang J. Risk factors of chronic subdural hematoma progression after conservative management of cases with initially acute subdural hematoma. Korean J Neurotrauma. 2015;11(2):52-7. http://doi.org/10.13004/kjnt.2015.11.2.52. PMid:27169065.

23. Sim YW, Min KS, Lee MS, Kim YG, Kim DH. Recent changes in risk factors of chronic subdural hematoma. J Korean Neurosurg Soc. 2012;52(3):234-9. http://doi.org/10.3340/jkns.2012.52.3.234. PMid:23115667.

24. De Bonis P, Trevisi G, de Waure C, et al. Antiplatelet/anticoagulant agents and chronic subdural hematoma in the elderly. PLoS One. 2013;8(7):e68732. http://doi.org/10.1371/journal.pone.0068732. PMid:23874740.

25. Mezue WC, Ohaebgulam SC, Chikani MC, Erechukwu AU. Changing trends in chronic subdural haematoma in Nigeria. Afr J Med Med Sci. 2011;40(4):373-6. PMid:22783688.

26. Ou Y, Dong J, Wu L, et al. The clinical characteristics, treatment, and outcomes of chronic subdural hematoma in young patients. World Neurosurg. 2019;125:e1241-6. http://doi.org/10.1016/j.wneu.2019.02.017. PMid:30797913.

27. Markwalder TM, Steinsiepe KF, Rohner M, Reichenbach W, Markwalder H. The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg. 1981;55(3):390-6. http://doi.org/10.3171/jns.1981.55.3.0390. PMid:7264730.

28. Lee JK, Choi JH, Kim CH, Lee HK, Moon JG. Chronic subdural hematomas: a comparative study of three types of operative procedures. J Korean Neurosurg Soc. 2009;46(3):210-4. http://doi.org/10.3340/ jkns.2009.46.3.210. PMid:19844620.

29. Abdelfatah M. Recurrence rate of chronic subdural hematoma after evacuating it by two large burr holes, irrigation, and subgaleal low-pressure suction drainage. Asian J Neurosurg. 2019;14(3):725-9. http://doi.org/10.4103/ajns.AJNS_321_17. PMid:31497092.

30. Ge R, Shen J. Gender-specific differences in chronic subdural hematoma. J Craniofac Surg. 2022;34(2):e124-8. http://doi.org/10.1097/ SCS.0000000000008855. PMid:36857560.

31. Aseged M, Leake T. Three-month outcome of patients operated for chronic subdural hematoma at four hospitals, Addis Ababa, Ethiopia, 2021GC. Interdiscip Neurosurg. 2023;34(6):1-9. http://doi.org/10.1016/j.inat.2023.101816.

32. Brennan PM, Kolias AG, Joannides AJ, et al, and the British Neurosurgical Trainee Research Collaborative. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg. 2017;127(4):732-9. http://doi.org/10.3171/2016.8.JNS16134. PMid:27834599.

33. Ishida T, Inoue T, Inoue T, et al. Functional outcome in patients with chronic subdural hematoma: postoperative delirium and operative procedure. Neurol Med Chir. 2022;62(4):171-6. http://doi.org/10.2176/ jns-nmc.2020-0319. PMid:35296584.

---

1Division of Neurosurgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria.

 

Received Dec 18, 2025

Accepted Jan 22, 2026