Early and late outcomes following surgical treatment of chronic subdural hematoma: a six-year retrospective cohort study.

Chronic subdural hematoma (CSDH) is a common neurosurgical disease, particularly in elderly patients, with variable clinical behavior and potential recurrence. Knowing both early and late postoperative results is paramount in optimizing patient management and reducing morbidity. We retrospectively analyzed 580 adult patients with CSDH who underwent burr-hole craniostomy from 2017 to 2023. Early (≤3 months) and late (>3 months) clinical and radiological outcomes were assessed. Hematoma volume and midline shift (MLS) were quantified using Infinitt PACS, a validated semi-automated segmentation platform, with an inter-rater intraclass correlation coefficient (ICC) exceeding 0.90, by neuroradiologists blinded to clinical data. Multivariate logistic regression identified independent predictors of recurrence. The cohort's mean age was 63.2 ± 19.2 years, with males comprising 79.8%. Postoperative imaging demonstrated substantial reductions in hematoma thickness and MLS (>88%). Recurrence rate was 7.2%. Residual postoperative hematoma thickness (Odds Ratio 1.185; p < 0.001) and MLS (OR 1.180; p = 0.015) were significant independent predictors of recurrence. Parietal burr-hole placement was associated with superior radiological outcomes compared to frontal approaches (p = 0.004). Late follow-up data underscored sustained recovery correlated with younger age and higher admission GCS scores. Integrating volumetric imaging with validated semi-automated assessment and standardized functional grading provides a robust framework for risk stratification in CSDH. Early and late postoperative evaluations reveal key predictors of recurrence and functional outcome. These findings support tailored surgical approaches complemented by vigilant postoperative follow-up to optimize patient care and reduce recurrence rates.