J Neurosurg. 2025 Nov 7:1-7. doi: 10.3171/2025.7.JNS251083. Online ahead of print.
ABSTRACT
OBJECTIVE: Chronic subdural hematoma (CSDH), a condition with high recurrence rates, is traditionally attributed to trauma-induced inflammation and angiogenesis. Emerging evidence suggests an association between clinically unapparent low-grade infection and recurrence. The role of subclinical low-grade infection in untreated primary CSDH remains unknown. The aim of this study was to examine intraoperative swab results in de novo CSDH to assess its association with recurrence.
METHODS: In this prospective study, patients undergoing primary surgical evacuation for CSDH were enrolled and intraoperative swabs were collected for microbiological analysis. Patients were followed up for 6 months after surgery to assess recurrence. The presence or absence of a positive intraoperative swab was used to dichotomize the cohort. Relevant clinical parameters, including preoperative comorbidities, intra- and perioperative management, recurrence rates, and follow-up information were compared between the two groups.
RESULTS: Eighty patients (60 male, median age 79 years) with CSDH were included in the analysis. Intraoperative swab cultures identified low-grade bacterial colonization, predominantly Cutibacterium acnes (69%), in 40% (32/80) of patients. Recurrence rates were significantly higher in patients with positive bacteria detection (31%, 10/32) compared with patients without bacteria detection (12.5%, 6/48) (OR 3.1, 95% CI 1.02-9.90; p < 0.039).
CONCLUSIONS: These findings substantiate the hypothesis that subclinical low-grade infection contributes to CSDH origination. Further trials evaluating perioperative antibiotic interventions are warranted.
PMID:41202297 | DOI:10.3171/2025.7.JNS251083
