Evaluation of Neuroendoscopy-Assisted Surgery for the Treatment of the Trabecular Subtype of Chronic Subdural Hematoma.

Abstract

This retrospective study compared the outcomes of neuroendoscopy-assisted small craniotomy (n = 26) and traditional burr hole drainage (n = 20) for the treatment of trabecular chronic subdural hematoma (CSDH). The 2 groups showed comparable baseline characteristics including age, sex, comorbidities, and medication use (all, P > 0.05). The neuroendoscopy group demonstrated several clinical advantages despite longer operative times (108.7 ± 45.2 vs. 92.5 ± 45.8 minutes, P < 0.05). Most notably, significantly lower recurrence (3.8% vs. 30%, P < 0.05) and postoperative seizure rates (3.8% vs. 25%, P < 0.05) were observed during the 6-month follow-up period. Both surgical approaches showed similar hospital stays (11.7 ± 3.2 vs. 10.2 ± 2.8 days) and rebleeding rates (3.8% vs. 15%). Functional recovery measures revealed better outcomes with neuroendoscopy, as evidenced by superior Modified Rankin Scale scores (1.1 ± 0.3 vs. 1.5 ± 1.0, P < 0.05). Both techniques resulted in significant postoperative improvements in Barthel Index scores (P < 0.05). Importantly, neither group experienced major complications such as cerebral infarction or surgical site infections. These findings suggest that neuroendoscopy-assisted surgery offers distinct advantages for trabecular CSDH management, particularly in reducing the recurrence risk and enhancing functional recovery. This technique appears safe and may represent a superior surgical option for this specific CSDH subtype.