Recurrence of chronic subdural hematoma due to low-grade infection

Daniel Dubinski; Sae-Yeon Won; Svorad Trnovec; Kseniya Gounko; Peter Baumgarten; Philipp Warnke; Daniel Cantré; Bedjan Behmanesh; Joshua D Bernstock; Thomas M Freiman; Florian Gessler; Steffen Sola

doi:10.3389/fneur.2022.1012255

Recurrence of chronic subdural hematoma due to low-grade infection

Front Neurol. 2022 Sep 23:13:1012255. doi: 10.3389/fneur.2022.1012255. eCollection 2022.

Affiliations

¹ Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany.
² Department of Neurosurgery, University Hospital, Schiller University Jena, Jena, Germany.
³ Institute for Medical Microbiology, Virology and Hygiene, Rostock University Medical Center, Rostock, Germany.
⁴ Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany.
⁵ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

Abstract

Despite the high incidence and multitudes of operative techniques, the risk factors for chronic subdural hematoma (CSDH) recurrence are still under debate and a universal consensus on the pathophysiology is lacking. We hypothesized that clinically inapparent, a low-grade infection could be responsible for CSDH recurrence. This investigation is a single-center prospective observational study including patients with recurrent CSDH. In total, 44 patients with CSDH recurrence received an intraoperative swab-based microbiological test. The intraoperative swab revealed an inapparent low-grade hematoma infection in 29% of the recurrent CSDH cases. The majority (69%) of the identified germs belonged to the staphylococcus genus. We therefore, propose a novel potential pathophysiology for CSDH recurrence.

Keywords: MMA occlusion; chronic subdural hematoma; dexamethasone; infected subdural hematoma recurrence; recurrence.