Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially in the elderly, which is usually diagnosed by computed tomography (CT) scan and often treated surgically. After surgery patients shows favourable outcomes with improvement in symptomatology. Despite the availability of various surgical techniques, complications continue to occur frequently due to the advanced age of patients and underlying medical conditions. Burr-hole craniotomy followed by placement a closed-system drainage is widely considered the best treatment for CSDH, although technical challenges and a high recurrence rate remain. Postoperative pneumocephalus is a potential risk factor for recurrence. While the majority of patients recover well after surgery, recurrence or persistence of CSDH occurs in 0.35–33% of cases, sometimes necessitating additional surgeries. Method: This retrospective study comprehensively evaluates the clinical data of 229 patients diagnosed with chronic subdural hematoma (CSDH) who underwent surgical intervention, specifically burr-hole craniotomy with drainage between 2016 and 2021. The primary objective is to measure the prognostic significance of postoperative pneumocephalus as a predictor of recurrence of CSDH. Furthermore, the obtained univariate and multivariate regression analyses examines various patient-specific factors, including age, gender, location of CSDH (unilateral or bilateral), anticoagulation therapy status, neurosurgical follow-up outcomes, hospital readmission rates, and the incidence of repeat surgical procedures. Result: Among the analysed characteristics, postoperative pneumocephalus exceeding a specified volumetric threshold emerges as the only significant predictor of CSDH recurrence. This recurrence of CSDH is additionally associated with a substantial prolongation of the patient’s hospitalization, highlighting its clinical and logistical significance. Conclusion: A postoperative pneumocephalus is nearly unavoidable; however, optimizing surgical technique to minimize its volume below 5.2 cm ³ reduces significantly the recurrence rate of CSDH.

Background/Objectives: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical disorders in older adults and remains associated with a relevant recurrence rate despite standardized surgical treatment. Identifying postoperative factors that predict recurrence may improve postoperative surveillance and surgical strategy. We therefore investigated whether the density of the residual hematoma on early postoperative computed tomography (CT) is associated with recurrence after burr-hole trepanation. Methods: We retrospectively analyzed all consecutive patients who underwent burr-hole trepanation for cSDH at our institution between 2016 and 2021. Residual hematoma density was measured in Hounsfield units (HU) on postoperative CT scans. Recurrence was defined as symptomatic hematoma reaccumulation requiring reoperation. Results: A total of 223 patients met the inclusion criteria. The overall recurrence rate was 20.2%. Mean residual hematoma density was significantly higher in the recurrence group than in the non-recurrence group (23.2 ± 13.1 HU vs. 19.0 ± 9.1 HU; p = 0.005). ROC analysis identified an optimal cutoff value of 19 HU (AUC 0.578, 95% CI 0.511–0.645; p = 0.022) with sensitivity of 57.8%, and a specificity of 57.9%. Patients with residual hematoma density ≥19 HU had a significantly higher recurrence rate than those with lower density (25.7% vs. 15.6%; p = 0.043). In multivariable logistic regression, higher residual density remained an independent predictor of cSDH recurrence (p = 0.008, OR 1.9; 95% CI 1.2–3.0). Conclusions: Higher postoperative residual hematoma density is an independent predictor of recurrence after burr-hole trepanation for cSDH. Residual density on early postoperative CT may serve as a simple and clinically accessible imaging marker of incomplete hematoma clearance and may help refine postoperative risk assessment. Nevertheless, the low AUC limits interpretation of predictive performance.

Introduction: The routine insertion of a postoperative intracranial drain following surgical evacuation of brain abscesses or subdural empyemas is practiced by some surgeons to facilitate pus evacuation and to enable cavity lavage, but robust evidence for clinical benefit is lacking. This study evaluates whether postoperative drain placement affects reoperation rates, length of hospital stay, and duration of antibiotic therapy. Methods: We performed a retrospective review of consecutive adult patients who underwent surgical drainage or excision of a primary intracranial abscess or empyema at our tertiary center between January 2020 and January 2026. Patients were grouped by whether a postoperative intracranial drain was placed. The primary endpoint was recurrence requiring reoperation. Secondary endpoints included hospital length of stay, total duration of antibiotic therapy, and operative time. Continuous variables were compared with t-tests and categorical variables with Fisher’s exact test; p < 0.05 was considered statistically significant. Results: Eighty procedures were identified, and 36 patients met inclusion criteria for final analysis; eight (22.2%) received a postoperative intracranial drain, and 28 (77.8%) did not. Overall, 13 patients (36.1%) required reoperation for radiological or clinical progression. Reoperation occurred in 50% of patients with a drain and 32.1% without a drain (p = 0.422). Median hospital stay and duration of antibiotic therapy did not differ significantly between groups (median hospital stay 27.1 vs. 23.0 days, p = 0.50; median antibiotic duration 67.3 vs. 51.7 days, p = 0.445). Operative time and infection volume rates were also similar between cohorts. Conclusions: In this single-center retrospective cohort, placement of a postoperative intracranial drain after surgical management of brain abscesses or empyemas was not associated with reduced reoperation rates, shorter hospitalization, or shorter antibiotic treatment. Given the absence of demonstrable clinical benefit and the potential risks related to drain placement, routine insertion of postoperative drains cannot be recommended.

Many patients suffering from aneurysmal subarachnoid hemorrhage (SAH) develop epileptic seizures. The recent guidelines do not recommend routine administration of antiepileptic drugs (AED). We performed a retrospective single-center study to analyze the effect of AEDs on the outcome in patients suffering from epilepsy after SAH. 752 patients with SAH treated between 01/2006 and 12/2020 were analyzed. Patients were divided into good-grade (WFNS grades I-II) versus poor-grade (WFNS grades III-V) on admission. Data of patients’ history as well as clinical course were collected. Outcome according to the modified Rankin scale (mRS) score was assessed at 6 months after ictus. Outcome was dichotomized into favorable (mRS 0–2) and unfavorable (mRS 3–6). Univariate and multivariate analyses were performed. 346 (46.0 %) patients suffered from poor-grade SAH and 366 (48.7 %) patients achieved unfavorable outcome. 202 (26.9 %) patients suffered from seizures after SAH and 136 (18.1 %) had to be treated with antiepileptic drugs (AEDs) for more than a week. Epilepsy and AED intake after 3 months was more often in patients with unfavorable outcome (18.9 % vs. 8.3 %; p < 0.001 and 21.9 % vs. 11.9 %; p < 0.001, respectively). In multivariate analysis, ‘poor-grade SAH’ (p < 0.001, OR 10.5, 95 % CI 6.0–18.2), ‘age >50 years’ (p = 0.001, OR 2.7, 95 % CI 1.5–4.8, ‘aneurysm size >10 mm’ (p = 0.018, OR 2.2, 95 % CI 1.1–4.1), ‘hydrocephalus’ (p = 0.002, OR 2.6, 95 % CI 1.4–4.7), ‘delayed cerebral ischemia’ (p = 0.002, OR 5.0, 95 % CI 2.3–10.9) and ‘epilepsy within 3 months’ (p = 0.002, OR 5.9, 95 % CI 1.9–18.3) were predictors for unfavorable outcome, whereas ‘AED intake after 6 months’ (p = 0.037, OR 0.35, 95 % CI 0.13–0.94) was predictor for favorable outcome. Manifestation of epilepsy in patients suffering from SAH deteriorates outcome. Continued AED intake in SAH patients who developed epileptic seizures should be advised.

Background: The prognostic assessment of patients with spinal metastases is primarily based on clinical and radiological parameters. Biological tumor characteristics such as the proliferation marker Ki-67 have prognostic relevance in various metastatic settings. This study aimed to evaluate the prognostic impact of the Ki-67 proliferation index on survival outcomes in patients undergoing surgery for spinal metastases. Methods: We included 166 patients who underwent surgical treatment for spinal metastases at our university clinic between 2015 and 2024. Clinical, functional, tumor-related, and perioperative variables were collected. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory ability of Ki-67, and comparisons were made between patient groups according to Ki-67 expression (≤20% vs. >20%). Results: Based on ROC analysis, Ki-67 demonstrated a moderate but significant predictive ability for 1-year mortality (area under the curve [AUC]: 0.69, p = 0.001). Patients with a Ki-67 index of >20% showed a significantly shorter overall survival than those with a lower Ki-67 index of ≤20% (median overall survival: 5.0 vs. 14.5 months, p < 0.001). One-year mortality was significantly higher in the high Ki-67 group (78.9% vs. 41.8%, p = 0.001). High Ki-67 expression was associated with more aggressive tumor characteristics but was not associated with increased perioperative morbidity. Conclusions: The Ki-67 proliferation index is a significant prognostic biomarker in surgically treated patients with spinal metastases. A Ki-67 index threshold of 20% identifies patients at increased risk of early mortality and significantly reduced overall survival.