• Hiroaki Matsumoto, Hiroaki Hanayama, Takashi Okada, Yasuo Sakurai, Hiroaki Minami, Atsushi Masuda, Shogo Tominaga, Katsuya Miyaji, Ikuya Yamaura, Yasuhisa Yoshida, and Kozo Yoshida.
• Department of Neurosurgery, Cerebrovascular Research Institute, Eishokai Yoshida Hospital, Kobe, Japan. Electronic address: hiroaki-matsu@umin.ac.jp.
• World Neurosurg. 2017 Nov 1; 107: 706-715.

BackgroundChronic subdural hematoma (CSDH) is sometimes refractory, and this is troublesome for neurosurgeons. Although many studies have reported risk factors or treatments in efforts to prevent recurrence, those have focused on single recurrence, and few cumulative data are available to analyze refractory CSDH.MethodsWe defined refractory CSDH as ≥2 recurrences, then analyzed and compared clinical factors between patients with single recurrence and those with refractory CSDH in a cohort study, to clarify whether patients with refractory CSDH experience different or more risk factors than patients with single recurrence, and whether burr-hole irrigation with closed-system drainage reduces refractory CSDH.ResultsSeventy-five patients had at least 1 recurrence, with single recurrence in 62 patients and ≥2 recurrences in 13 patients. In comparing clinical characteristics, patients with refractory CSDH were significantly younger (P = 0.04) and showed shorter interval to first recurrence (P < 0.001). Organized CSDH was also significantly associated with refractory CSDH (P = 0.02). Multivariate logistic regression analysis identified first recurrence interval <1 month (odds ratio, 6.66, P < 0.001) and age <71 years (odds ratio, 4.16, P < 0.001) as independent risk factors for refractory CSDH. On the other hand, burr-hole irrigation with closed-system drainage did not reduce refractory CSDH.ConclusionsWhen patients with risk factors for refractory CSDH experience recurrence, alternative surgical procedures may be considered as the second surgery, because burr-hole irrigation with closed-system drainage did not reduce refractory CSDH in our study.Copyright © 2017 Elsevier Inc. All rights reserved.

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