TY - JOUR
T1 - Predictors of recurrence and reintervention in non-acute subdural hematoma
T2 - A multimodal analysis of radiological, clinical, surgical, and endovascular factors
AU - Luzardo-Neira, C. Alejandro
AU - Muñoz-Ordoñez, José Rodrigo
AU - Alvarado-Bedoya, Camilo
AU - Lara-Coba, Brunno
AU - García-Ledesma, Oscar Eduardo
AU - Mejía-Quiñones, Valentina
AU - Mejía, Juan Andrés
AU - Olarte, Laura
AU - Rendón, Ana María
AU - Roa, Carlos
AU - Campaña-Perilla, Laura
AU - Florez, Micxael
AU - Montoya, Yeisson Esteban
AU - Acosta, Mauricio
AU - Serrano-Gomez, Sergio
AU - Vasquez, Andrés
AU - Ortiz-Giraldo, Andrés Felipe
AU - Ferreira-Prada, Carlos Andrés
AU - Vargas, Oliverio
AU - Mantilla, Daniel
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.
PY - 2026/12
Y1 - 2026/12
N2 - Non-acute subdural hematomas (naSDH), encompassing subacute and chronic subdural hematomas, are a common neurosurgical condition in older adults with substantial recurrence rates after treatment. Management has become increasingly multimodal, combining surgical and endovascular strategies; however, the influence of clinical, radiological, surgical and technical factors on recurrence and reintervention remains under investigation. We conducted a retrospective multicenter cohort study including patients from six high-complexity neurosurgical and neurointerventional referral centers in Colombia between January 2023 and June 2025. Adult patients with symptomatic non-acute subdural hematoma confirmed by CT were included. Hematomas were managed with surgery alone, combined surgery and middle meningeal artery embolization, or embolization alone. Recurrence and reintervention were evaluated as outcomes. Univariable and multivariable logistic regression analyses were performed to identify factors associated with the primary outcomes. A total of 247 naSDH were analyzed. Recurrence occurred in 51 hematomas (20.6%) and reintervention in 44 (17.8%). In multivariable analysis, smoking (OR 9.59, 95% CI 1.93–47.52), hypertension (OR 5.23, 95% CI 1.14–23.93), increasing age (OR 1.07, 95% CI 1.00–1.16), and greater hematoma thickness (OR 1.20, 95% CI 1.05–1.37) were independently associated with recurrence. Combined surgery with embolization was associated with reduced recurrence (OR 0.44, 95% CI 0.22–0.88). Among surgical variables, post-drain pneumocephalus significantly increased recurrence risk (OR 13.32, 95% CI 2.83–62.65), whereas longer durostomy drainage duration reduced the recurrence (OR 0.51, 95% CI 0.30–0.85). Endovascular technical factors were not independently associated with recurrence. Clinical factors showed the strongest association with recurrence. Combined surgery and embolization showed a protective association, while postoperative pneumocephalus and drainage duration significantly influenced possible outcomes.
AB - Non-acute subdural hematomas (naSDH), encompassing subacute and chronic subdural hematomas, are a common neurosurgical condition in older adults with substantial recurrence rates after treatment. Management has become increasingly multimodal, combining surgical and endovascular strategies; however, the influence of clinical, radiological, surgical and technical factors on recurrence and reintervention remains under investigation. We conducted a retrospective multicenter cohort study including patients from six high-complexity neurosurgical and neurointerventional referral centers in Colombia between January 2023 and June 2025. Adult patients with symptomatic non-acute subdural hematoma confirmed by CT were included. Hematomas were managed with surgery alone, combined surgery and middle meningeal artery embolization, or embolization alone. Recurrence and reintervention were evaluated as outcomes. Univariable and multivariable logistic regression analyses were performed to identify factors associated with the primary outcomes. A total of 247 naSDH were analyzed. Recurrence occurred in 51 hematomas (20.6%) and reintervention in 44 (17.8%). In multivariable analysis, smoking (OR 9.59, 95% CI 1.93–47.52), hypertension (OR 5.23, 95% CI 1.14–23.93), increasing age (OR 1.07, 95% CI 1.00–1.16), and greater hematoma thickness (OR 1.20, 95% CI 1.05–1.37) were independently associated with recurrence. Combined surgery with embolization was associated with reduced recurrence (OR 0.44, 95% CI 0.22–0.88). Among surgical variables, post-drain pneumocephalus significantly increased recurrence risk (OR 13.32, 95% CI 2.83–62.65), whereas longer durostomy drainage duration reduced the recurrence (OR 0.51, 95% CI 0.30–0.85). Endovascular technical factors were not independently associated with recurrence. Clinical factors showed the strongest association with recurrence. Combined surgery and embolization showed a protective association, while postoperative pneumocephalus and drainage duration significantly influenced possible outcomes.
KW - Middle meningeal artery embolization
KW - Multimodal treatment
KW - Non-acute subdural
KW - Postoperative pneumocephalus
KW - Recurrence
KW - Reintervention
KW - Risk factors
KW - Surgical drainage
KW - hematoma
UR - https://www.scopus.com/pages/publications/105046545094
U2 - 10.1007/s10143-026-04428-1
DO - 10.1007/s10143-026-04428-1
M3 - Artículo Científico
C2 - 42552422
AN - SCOPUS:105046545094
SN - 0344-5607
VL - 49
JO - Neurosurgical Review
JF - Neurosurgical Review
IS - 1
M1 - 513
ER -