Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients
Background: Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition with a significant recurrence rate. Identifying patients at risk of recurrence is a topic of great interest to intercept this population in which to implement further therapeutic strategies. Objective: To develop and...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425001055 |
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| author | Francesco M.C. Lioi Jon Ramm-Pettersen Andrea Fratini Gabriele Dentato Giovanni Facchinetti Niccolo Colella Luigi Rosito Elena Furno Camilla Riva Andrea G. Ruggeri Luca D'Angelo Antonio Santoro Alessandro Frati |
| author_facet | Francesco M.C. Lioi Jon Ramm-Pettersen Andrea Fratini Gabriele Dentato Giovanni Facchinetti Niccolo Colella Luigi Rosito Elena Furno Camilla Riva Andrea G. Ruggeri Luca D'Angelo Antonio Santoro Alessandro Frati |
| author_sort | Francesco M.C. Lioi |
| collection | DOAJ |
| description | Background: Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition with a significant recurrence rate. Identifying patients at risk of recurrence is a topic of great interest to intercept this population in which to implement further therapeutic strategies. Objective: To develop and internally validate a risk-stratification score using preoperative radiological parameters to predict risk of CSDH recurrency. To establish a stratification approach based on easily available clinical and radiological variables. Methods: A retrospective analysis of 118 consecutive patients surgically treated for CSDH was conducted. Binary logistic regression was used to identify radiological preoperative predictors of recurrence, including Nakaguchi classification, cortical atrophy, and hematoma density. Results: A weighted scoring system has been developed and patients were stratified into three risk categories: low (0–2 points), moderate (3–5 points), and high (6–8 points). This grading system demonstrated a significant correlation with recurrence rates: 0 % in the low-risk group, 11.76 % in the moderate-risk group, and 25.71 % in the high-risk group. The model exhibited good discriminative ability in predicting the risk of CSDH recurrence. Conclusion: Hyperdense appearance, homogeneous or separated Nakaguchi-configuration and presence of cortical atrophy are predictive features of CSDH recurrence and can be incorporated into a score. The proposed grading system provides an effective preoperative tool for assessing CSDH recurrence risk, with a progressive increase in the recurrency rate between the three groups. This model enables personalized postoperative management, facilitating early identification of high-risk patients who may benefit from adjunctive treatments to reduce recurrence. |
| format | Article |
| id | doaj-art-4bc72300b774467b80eaad053d82cb2e |
| institution | OA Journals |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-4bc72300b774467b80eaad053d82cb2e2025-08-20T02:37:41ZengElsevierBrain and Spine2772-52942025-01-01510428610.1016/j.bas.2025.104286Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patientsFrancesco M.C. Lioi0Jon Ramm-Pettersen1Andrea Fratini2Gabriele Dentato3Giovanni Facchinetti4Niccolo Colella5Luigi Rosito6Elena Furno7Camilla Riva8Andrea G. Ruggeri9Luca D'Angelo10Antonio Santoro11Alessandro Frati12Sapienza University of Rome, Rome, Italy; Corresponding author. Department of Neurosurgery Policlinico Umberto Primo, Rome Sapienza University of Rome, Rome Viale del Policlinico 155, Rome, Italy.Oslo University Hospital, Oslo, NorwaySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalySapienza University of Rome, Rome, ItalyBackground: Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition with a significant recurrence rate. Identifying patients at risk of recurrence is a topic of great interest to intercept this population in which to implement further therapeutic strategies. Objective: To develop and internally validate a risk-stratification score using preoperative radiological parameters to predict risk of CSDH recurrency. To establish a stratification approach based on easily available clinical and radiological variables. Methods: A retrospective analysis of 118 consecutive patients surgically treated for CSDH was conducted. Binary logistic regression was used to identify radiological preoperative predictors of recurrence, including Nakaguchi classification, cortical atrophy, and hematoma density. Results: A weighted scoring system has been developed and patients were stratified into three risk categories: low (0–2 points), moderate (3–5 points), and high (6–8 points). This grading system demonstrated a significant correlation with recurrence rates: 0 % in the low-risk group, 11.76 % in the moderate-risk group, and 25.71 % in the high-risk group. The model exhibited good discriminative ability in predicting the risk of CSDH recurrence. Conclusion: Hyperdense appearance, homogeneous or separated Nakaguchi-configuration and presence of cortical atrophy are predictive features of CSDH recurrence and can be incorporated into a score. The proposed grading system provides an effective preoperative tool for assessing CSDH recurrence risk, with a progressive increase in the recurrency rate between the three groups. This model enables personalized postoperative management, facilitating early identification of high-risk patients who may benefit from adjunctive treatments to reduce recurrence.http://www.sciencedirect.com/science/article/pii/S2772529425001055Chronic subdural hematomaGrading systemScoreRecurrencePrediction |
| spellingShingle | Francesco M.C. Lioi Jon Ramm-Pettersen Andrea Fratini Gabriele Dentato Giovanni Facchinetti Niccolo Colella Luigi Rosito Elena Furno Camilla Riva Andrea G. Ruggeri Luca D'Angelo Antonio Santoro Alessandro Frati Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients Brain and Spine Chronic subdural hematoma Grading system Score Recurrence Prediction |
| title | Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients |
| title_full | Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients |
| title_fullStr | Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients |
| title_full_unstemmed | Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients |
| title_short | Recurrence prediction in chronic subdural hematomas: a risk stratification score based on 118 consecutive patients |
| title_sort | recurrence prediction in chronic subdural hematomas a risk stratification score based on 118 consecutive patients |
| topic | Chronic subdural hematoma Grading system Score Recurrence Prediction |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425001055 |
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