Correlation between modified computed tomography classification and chronic subdural hematoma progression

Abstract

Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Although surgical treatment is often successful, conservative treatment have continuously increased the chances of a successful outcome. The aim of the present review is to collect existing data on pathophysiology of CSDH, using cranial computed tomography (CT) to predict the progression of a hematoma. From January 2015 to April 2021, a retrospective and descriptive study was conducted in Panyananthaphikkhu Chonprathan Medical Center in Nonthaburi, Thailand. An inventory was taken from all patients diagnosed with CSDH. The patients were evaluated according to Modified CT classification. All patients initially received a brain CT scan. The studied variables were demographic characteristics, including underlying diseases, a history of head trauma and hematoma volume on follow-up brain CT scan. This included 80 patients with CSDH 97 lesions. They were classified into five groups according to modified CT classification: homogenous type (n=44), laminar type (n=13), gradation type (n=19), separated type (n=10), and trabecular type (n=11). The study showed that the gradation type was significantly related with a progression of subdural hematoma size at the one-month follow-up of brain scan (odd ratio = 6.61, 95% confidence interval = 1.61 - 27.08). A gradation type of CSDH on CT scan was the strongest predictor of hematoma progression, while a history of prior head trauma and dyslipidemia were also related to the progression of CSDH.