Acute symptomatic seizures (ASz) are a recognized postoperative complication following burr hole drainage for chronic subdural hematoma (CSDH); however, the risk factors remain poorly understood. This study aimed to identify clinical and radiological predictors of early postoperative seizures in CSDH patients, with the goal of enhancing risk stratification and informing individualized management approaches.

A retrospective analysis was conducted on 266 patients who underwent burr hole drainage for CSDH between 2022 and 2024. Data on demographics, comorbidities, hematoma characteristics, and postoperative complications, including seizures, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of early postoperative ASz.

ASz occurred in 10 patients (3.8%), with 4 experiencing isolated seizures and 6 having status epilepticus. Univariable analysis identified prior stroke (OR = 9.5, 95% CI [2.2–42.0], p = 0.011), diabetes mellitus (OR = 4.2, 95% CI [1.2–15.2], p = 0.032), and separated hematoma type (OR = 5.4, 95% CI [1.5–19.5], p = 0.015) as significant predictors of ASz. However, in multivariate analysis, prior stroke remained a significant independent predictor (OR = 6.4, 95% CI [1.3–30.9], p = 0.021), while diabetes mellitus and separated hematoma type were no longer statistically significant.

Prior stroke is the most consistent predictor of early postoperative seizures following burr hole drainage for CSDH. While diabetes mellitus and separated hematoma type showed initial associations, these did not persist in adjusted analysis.