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--- recurrent_chronic_subdural_hematoma [2025/07/16 14:57] – administrador
+++ recurrent_chronic_subdural_hematoma [2025/07/16 14:59] (current) – administrador
@@ Line 1: / Line 1: @@
 ====== 🧠 Recurrent Chronic Subdural Hematoma (rCSDH) ======
-===== 📚 Definition =====
+see [[Chronic subdural hematoma recurrence]].
-A '''recurrent [[chronic subdural hematoma]]''' is the re-accumulation of blood in the [[subdural space]] after surgical evacuation of a previous chronic subdural hematoma. Recurrence typically occurs within weeks to months and affects 5–30% of cases depending on technique and patient factors.
-===== 🔍 Etiopathogenesis =====
-Chronic subdural hematomas (CSDH) arise from venous bleeding (usually bridging veins), compounded by:
-  * Fragile neomembrane formation
-  * Inflammatory response and angiogenesis
-  * Ongoing fibrinolysis within the capsule
-'''Recurrence''' occurs due to:
-  * Incomplete brain re-expansion
-  * Residual membranes or compartments
-  * Persistence of subdural space
-  * Coagulopathy or antithrombotic therapy
-===== 📈 Risk Factors for Recurrence =====
-  * Age > 75 years
-  * Antiplatelet/anticoagulant use
-  * Bilateral hematomas
-  * Low brain expansion post-op
-  * Large residual subdural cavity
-  * No drainage left post-op
-  * Non-irrigated burr holes
-  * Poorly controlled hypertension
-  * Chronic alcohol use or hepatic dysfunction
-===== 🏥 Diagnosis =====
-  * **Clinical**: Return of symptoms (confusion, focal deficits, gait issues)
-  * **Radiological**:
-    - CT: hypodense/isodense collection with mass effect
-    - MRI: useful in atypical or recurrent cases
-===== 🛠️ Management =====
-==== Initial Evacuation ====
-  * Burr hole craniostomy (BHC) + closed drainage (24–48h)
-  * Twist-drill craniostomy in fragile patients
-  * Mini-craniotomy in multiloculated or recurrent cases
-==== Recurrence Treatment ====
-  * Re-operation via burr hole or craniotomy
-  * Membranectomy if thickened capsule causes compartmentalization
-  * **Middle Meningeal Artery Embolization (MMAE)**:
-    - Adjunct to surgery or alternative in high-risk cases
-    - Reduces recurrence by occluding capsule vascular supply
-===== 💉 MMA Embolization =====
-  * Performed endovascularly via radial/femoral access
-  * Embolizes MMA branches feeding outer membrane
-  * Used as:
-    - Primary treatment in mild/recurrent cases
-    - Adjunct after evacuation to prevent recurrence
-  * Recurrence reduced to <10% in some studies
-===== 📉 Prognosis =====
-  * Good overall outcome with prompt intervention
-  * Recurrence does not usually imply malignant course
-  * Prognosis worsens with:
-    - Baseline frailty
-    - Seizures
-    - Neurological deterioration at recurrence
-===== 📌 Summary =====
-^ Aspect              ^ Details                             ^
-| Recurrence Rate     | 5–30%                               |
-| Imaging             | CT (standard), MRI (selected cases) |
-| Treatment           | BHC ± Drain ± MMAE                  |
-| Prevention          | Subdural drain, MMA embolization    |
-| High-Risk Patients  | Elderly, anticoagulated, alcoholic  |
-----
-**Note**: For decision algorithms or MMAE protocols, see [[neurovascular:middle_meningeal_artery_embolization]] or [[neurotrauma:csdh]].