Neurol Neurochir Pol. 2026 Jan 30. doi: 10.5603/pjnns.109813. Online ahead of print.
ABSTRACT
INTRODUCTION: Intracranial hemorrhage (ICH) after surgical evacuation of chronic subdural hematoma (cSDH) is a rare but serious complication associated with considerable morbidity and mortality. This review aims to provide an updated estimate, from existing literature, of the prevalence of ICH and to analyze the clinical features, potential risk factors, treatment approaches, and outcomes in a cohort of 76 patients.
CLINICAL RATIONALE FOR THE STUDY: Because postoperative ICH can rapidly deteriorate neurological status and complicate recovery, understanding its prevalence and determinants is essential for improving safety in cSDH surgery.
MATERIAL AND METHODS: Two systematic searches of the PubMed, Scopus, and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases were conducted in accordance with Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines on September 20th, 2025. The first search resulted in the inclusion of 18 articles, which were included in an analysis of the prevalence of ICH. The second search resulted in the inclusion of 56 articles, encompassing detailed clinical data on 76 patients who experienced postoperative ICH following surgical evacuation of cSDH.
RESULTS: The prevalence of ICH after cSDH surgery was 2.3%. Patients' ages ranged from 22 to 93 years (mean: 66.5 years), with 79% being male. The most common type of postoperative ICH was intraparenchymal hemorrhage (IPH) (73.7%), followed by subdural hemorrhage (14.5%). ICH occurred on average 1.7 days after the procedure. Dominant symptoms of ICH post evacuation included the following: altered mental status (47.4%), motor weakness (30.3%), and headache (21.05%). Significant correlations between preoperative hypertension, antiplatelet therapy, IPH, and worse outcome (mRS > 3) have been established.
CONCLUSION AND CLINICAL IMPLICATIONS: The data suggest that patients suffering from hypertension and using antiplatelet therapy may be predisposed to poorer outcomes. Stratification of patients based on comorbidities, scrupulous preparation of patients, and careful perioperative care may play a role in reducing ICH occurrence and improving patient prognosis.
PMID:41615285 | DOI:10.5603/pjnns.109813