Background/Objectives: Chronic subdural hematoma (cSDH) is a common disease of growing significance due to the increasing use of antithrombotic drugs and population aging. There exists conflicting observational evidence that previous treatment with angiotensin-converting enzyme (ACE) inhibitors reduces the rate of cSDH recurrence. This study assesses the hypothesis that ACE inhibitors may affect recurrence rates by altering hematoma membrane formation. Methods: All patients with chronic subdural hematoma who were operated upon in a single university hospital between 2015 and 2020 were considered for inclusion. Hematomas were classified according to their structural appearance in computed tomography (CT) imaging into one of eight subtypes. Patients’ own medication, prior to hospitalization for cSDH treatment, was noted, and the use of ACI-inhibitors was identified. Results: Of the included 398 patients, 142 (35.9%) were treated with ACE inhibitors before admission for cSDH treatment. Of these, 115 patients (81.0%) received ramipril, 13 received patients lisinopril (11.3%), and 11 patients (9.6%) received enalapril. Reflecting cardiovascular comorbidity, patients on ACE inhibitors were more often simultaneously treated with antithrombotics (63.4% vs. 42.6%; p ≤ 0.001). Hematomas with homogenous hypodense (OR 11.739, 95%CI 2.570 to 53.612; p = 0.001), homogenous isodense (OR 12.204, 95%CI 2.669 to 55.798; p < 0.001), and homogenous hyperdense (OR 9.472, 95%CI 1.718 to 52.217; p < 0.001) architectures, as well as the prior use of ACE inhibitors (OR 2.026, 95%CI 1.214 to 3.384; p = 0.007), were independently associated with cSDH recurrence. Conclusions: Once corrected for hematoma architecture, type of surgery, and use of antithrombotic medication, preoperative use of ACE inhibitors was associated with a twofold increase in the likelihood of hematoma recurrence.

Traumatic brain injury (TBI) contributes to death and disability, resulting in an enormous individual and socio-economic challenges. Despite huge efforts, there are still controversies on treatment strategies and early outcome estimation. We evaluate current randomized controlled trials (RCTs) on TBI according to their fulfillment of the CONSORT (Consolidated Statement of Reporting Trials) statement’s criteria as a marker of transparency and the quality of study planning and realization. A PubMed search for RCTs on TBI (January 2014–December 2019) was carried out. After screening of the abstracts (n = 1.926), the suitable full text manuscripts (n = 72) were assessed for the fulfillment of the CONSORT criteria. The mean ratio of consort statement fulfillment was 59% (±13%), 31% of the included studies (n = 22) complied with less than 50% of the CONSORT criteria. Citation frequency was moderately related to ratio of CONSORT item fulfillment (r = 0.4877; p < 0.0001) and citation frequency per year (r = 0.5249; p < 0.0001). The ratio of CONSORT criteria fulfillment was associated with the impact factor of the publishing journal (r = 0.6428; p < 0.0001). Essential data for study interpretation, such as sample size determination (item 7a), participant flow (item 13a) as well as losses and exclusions (item 13b), were only reported in 53%, 60% and 63%, respectively. Reporting and methodological aspects in RCTs on TBI still may be improved. Thus, the interpretation of study results may be hampered due to methodological weaknesses.

Background: Young children requiring neurosurgical care frequently undergo repeated neuroimaging. Whereas CT involves exposure to ionizing radiation, conventional MRI is time-consuming and often necessitates sedation in non-cooperative children. To address these limitations, ultrafast cranial MRI (UF-MRI) based on T2-HASTE sequences was implemented at our institution in 2019 for selected indications. The aim of this study was to evaluate the real-world implementation of UF-MRI in children younger than six years of age. Methods: We retrospectively analyzed cranial MRI examinations consisting exclusively of ultrafast sequences performed between July 2019 and December 2024 in children younger than six years. Clinical settings, diagnostic adequacy, immediate consequences for patient management, and the impact on MRI and CT utilization were systematically assessed. Results: A total of 404 UF-MRI examinations were performed in 198 inpatients and outpatients (mean age: 2 years 2 months) without the need for dedicated anesthesia team support solely for imaging. Only one examination (0.2%) required same-day repetition after mild oral sedation. In 20 patients (5.0%), UF-MRI was supplemented by conventional MRI under anesthesia, most commonly for preoperative planning. Immediate clinical consequences included no change in management in 54.5% of examinations, early follow-up in 22.8%, shunt valve adjustment in 11.6%, neurosurgical intervention in 7.7%, and other measures in 5.0%. UF-MRI accounted for 24.5% of all cranial MRI examinations in this age group and was associated with a 41% reduction in CT utilization compared with the corresponding period prior to UF-MRI implementation. Conclusions: In routine clinical practice, UF-MRI provides rapid, clinically sufficient neuroimaging in young children without the need for sedation or exposure to ionizing radiation. Its implementation significantly streamlines imaging workflows, optimizes resources utilization, reduces the need for CT, and supports timely clinical decision-making, underscoring its value as a complementary imaging modality in pediatric neuroimaging.

Objective: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with rising incidence in the aging population. Recurrence after surgical evacuation remains frequent, affecting up to one third of patients. Prior studies have proposed an association between ABO blood type and recurrence risk, though the findings are inconsistent. This study aimed to determine whether ABO blood group independently predicts cSDH recurrence after adjusting for clinical and radiological risk factors and to contextualize these findings in the context of previously published studies. Methods: We conducted a retrospective cohort study of all consecutive patients surgically treated for cSDH at University Hospital RWTH Aachen between 2015 and 2023. Clinical, laboratory, and imaging data, including hematoma volume, laterality, and architecture, were extracted from medical records. The primary outcome was recurrence requiring reintervention. Associations between ABO blood type and recurrence were assessed using chi-square tests and multivariable logistic regression. A random-effects meta-analysis was performed to integrate our findings with all identified prior studies reporting recurrence stratified by blood type. Results: Of 630 treated patients, 488 with documented ABO blood type and recurrence status were included. Recurrence occurred in 31.1% of these patients. ABO distribution matched European population frequencies. Univariate analysis showed no association between blood type and recurrence (p = 0.434). Adjusted models likewise showed no significant differences between type A and type B (OR 1.43, 95% CI 0.67–3.00), type AB (OR 2.35, 95% CI 0.74–7.24), and type O (OR 0.95, 95% CI 0.57–1.58). Hematoma architecture remained strongly associated with recurrence (p < 0.001). A meta-analysis of available studies similarly demonstrated no association between any ABO blood type and recurrence, with pooled odds ratios near unity across comparisons. Conclusions: ABO blood type was not associated with cSDH recurrence in our cohort, and pooled evidence from previously published studies confirms the absence of a meaningful effect. Hematoma architecture and volume remain the most important predictors of recurrence. Based on these results, blood type should not influence postoperative surveillance or counseling, and future work should focus on modifiable biological and imaging-based determinants of recurrence.

Background/Objectives: Chronic subdural hematoma (cSDH) is an increasingly prevalent neurosurgical condition in the aging population. Burr hole craniotomy (BHC) with irrigation and postoperative drainage represents the evidence-based standard of care, yet recurrence rates remain substantial. Twist drill craniostomy (TDC), a minimally invasive bedside procedure performed under local anesthesia, offers theoretical advantages for frail patients but has been largely abandoned due to concerns regarding incomplete evacuation and recurrence. This study aimed to identify the predictors of a successful TDC outcome and to compare the recurrence rates between TDC and BHC. Methods: We performed a retrospective cohort study of consecutive patients undergoing surgical treatment for radiologically confirmed cSDH at RWTH Aachen University Hospital between 2015 and 2023. Hematoma morphology was classified using an extended CT-based architecture system and grouped into homogeneous, organized, sedimented, or subacute categories. The primary endpoint was recurrence requiring surgical reintervention. Multivariable logistic regression was used to identify independent predictors of recurrence among patients discharged after definitive TDC. Propensity score matching was performed to compare recurrence rates between TDC and BHC while adjusting for baseline demographic, clinical, and radiographic differences. Results: Among 178 patients initially treated with TDC, 56 (31.5%) were discharged without conversion to BHC. Late recurrence occurred in 26 of 56 patients (46.4%) treated definitively with TDC. In multivariable analysis, homogeneous hematoma architecture was the only independent predictor of recurrence (adjusted OR 4.48, 95% CI 1.10–22.07, p = 0.037). Propensity score matching yielded 48 well-balanced pairs of TDC and BHC patients. Recurrence rates remained significantly higher after TDC compared with BHC (42.6% vs. 17.0%, p = 0.012), as confirmed by conditional logistic regression (adjusted OR 3.20, 95% CI 1.17–8.73). Conclusions: Twist drill craniostomy may provide definitive treatment in carefully selected patients but is associated with substantially higher recurrence rates than burr hole craniotomy, particularly in homogeneous hematomas. Burr hole evacuation remains the preferred standard approach, while optimized drainage protocols and architecture-guided selection may define a limited role for TDC in high-risk patients.