Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Transformation of contralateral subdural effusion into hematoma following evacuation of unilateral chronic subdural hematoma: incidence, predictors, and outcomes.
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Shen Jun, Lu Yuanyuan, An Qian, Zhou Zihao, Li Ziji, Ge Ruixiang, Jiang Xiaochun, Zhang Shaolin
Аннотация
OBJECTIVE: The progression of contralateral hematoma following unilateral evacuation in cases of bilateral chronic subdural hematoma (CSDH) has been increasingly recognized. However, the postoperative evolution of contralateral subdural effusion (SDE) in patients with unilateral CSDH (uCSDH) remains poorly understood. This study aimed to investigate the incidence, risk factors, and clinical outcomes of contralateral SDE (CSDE) transforming into CSDH after unilateral burr-hole evacuation.
METHODS: We retrospectively analyzed patients with uCSDH accompanied by CSDE who underwent burr-hole evacuation between October 2012 and April 2025. Clinical and radiological variables were compared between patients with and without postoperative transformation of CSDE into CSDH. Multivariable logistic regression analysis was performed to identify associated factors, and receiver operating characteristic (ROC) curves were generated to assess predictive performance.
RESULTS: Among 72 patients with uCSDH and CSDE, 16 (22.2 %) developed delayed transformation of CSDE into CSDH during follow-up. The transformation occurred 9-99 days postoperatively (mean, 41.5 days). Multivariable analysis identified surgical side CSDH developed from SDE (OR = 9.968, 95 % CI: 1.549-64.129) and widespread-type CSDE (SDE located on the frontal, temporal, and parietal lobes) (OR = 17.866, 95 % CI: 2.237-142.718) as associated factors of transformation. ROC analysis demonstrated acceptable discriminatory ability for widespread-type CSDE (AUC = 0.785). Most transformed hematomas resolved spontaneously, with only a minority requiring reoperation.
CONCLUSION: CSDE accompanying uCSDH is not always a benign postoperative finding. Approximately one-fifth of patients may develop delayed contralateral hematoma formation following unilateral evacuation. Widespread CSDE and surgical side CSDH developed from SDE are associated factors, highlighting the need for enhanced postoperative monitoring and personalized follow-up strategies.
ABBREVIATIONS: AUC, area under the curve; bCSDHs, bilateral chronic subdural hematomas; CI, confidence interval; CSDE, contralateral subdural effusion; CSDH, chronic subdural hematoma; GCS, Glasgow Coma Scale; OR, odds ratio; ROC, receiver operating characteristic; S.D, standard deviation; SDE, subdural effusion; uCSDH, unilateral chronic subdural hematoma.
METHODS: We retrospectively analyzed patients with uCSDH accompanied by CSDE who underwent burr-hole evacuation between October 2012 and April 2025. Clinical and radiological variables were compared between patients with and without postoperative transformation of CSDE into CSDH. Multivariable logistic regression analysis was performed to identify associated factors, and receiver operating characteristic (ROC) curves were generated to assess predictive performance.
RESULTS: Among 72 patients with uCSDH and CSDE, 16 (22.2 %) developed delayed transformation of CSDE into CSDH during follow-up. The transformation occurred 9-99 days postoperatively (mean, 41.5 days). Multivariable analysis identified surgical side CSDH developed from SDE (OR = 9.968, 95 % CI: 1.549-64.129) and widespread-type CSDE (SDE located on the frontal, temporal, and parietal lobes) (OR = 17.866, 95 % CI: 2.237-142.718) as associated factors of transformation. ROC analysis demonstrated acceptable discriminatory ability for widespread-type CSDE (AUC = 0.785). Most transformed hematomas resolved spontaneously, with only a minority requiring reoperation.
CONCLUSION: CSDE accompanying uCSDH is not always a benign postoperative finding. Approximately one-fifth of patients may develop delayed contralateral hematoma formation following unilateral evacuation. Widespread CSDE and surgical side CSDH developed from SDE are associated factors, highlighting the need for enhanced postoperative monitoring and personalized follow-up strategies.
ABBREVIATIONS: AUC, area under the curve; bCSDHs, bilateral chronic subdural hematomas; CI, confidence interval; CSDE, contralateral subdural effusion; CSDH, chronic subdural hematoma; GCS, Glasgow Coma Scale; OR, odds ratio; ROC, receiver operating characteristic; S.D, standard deviation; SDE, subdural effusion; uCSDH, unilateral chronic subdural hematoma.