Objective To evaluate the clinical efficacy and safety of neuroendoscopic hematoma evacuation versus middle meningeal artery (MMA) embolization in the treatment of chronic subdural hematoma (CSDH). Methods A retrospective analysis was conducted on the clinical data of 120 patients with chronic subdural hematoma admitted to our hospital between January 2020 to December 2024. According to the surgical approach, patients were allocated into Group A (Endoscopy group, n=60) and Group B (Embolization group, n=60). The operative time, estimated blood loss, hospitalization duration, postoperative complications (including pneumocephalus, epileptic seizures, acute hemorrhage, brain tissue injury and puncture site hematoma), and the 6-month recurrence rate were compared between the two groups. Results All procedures were successfully completed in both groups. Group B demonstrated statistically significant superiority over Group A in terms of operative time, estimated blood loss, and length of hospital stay (P<0.05). Regarding postoperative complications, Group A had 10 cases (16.67%) of pneumocephalus and 2 cases (3.33%) of epileptic seizures. Group B experienced 3 cases (5.00%) of puncture site hematoma in the groin area. There was statistically significant difference in overall complication rate between the two groups (P<0.05). During the 6-month follow-up period, the recurrence rate was 8 cases (13.33%) in Group A and 2 cases (3.33%) in Group B, with a statistically significant difference (P<0.05). Conclusions Neuroendoscopy enables rapid hematoma evacuation, septation management, and electrocoagulation under close visualization, achieving immediate decompression. However, it is associated with craniotomy-related trauma and postoperative pneumocephalus. In contrast, MMA embolization is minimally invasive, associated with a short hospital stay, promotes spontaneous hematoma absorption, and offers fewer complications and a lower recurrence rate, demonstrating great potential for clinical application.
Key words
Chronic subdural hematoma; /
Neuroendoscopy; /
Middle meningeal artery; /
/
Embolization; /
Efficacy analysis; /
/
Recurrence rate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Aljabali A, Sharkawy AM, Jaradat B, et al. Drainage versus no drainage after burr-hole evacuation of chronic subdural hematoma: a systematic review and meta-analysis of 1961 patients [J]. Neurosurg Rev, 2023, 46(1): 251. DOI:10.1007/s10143-023-02153-7.
[2] Singh H, Patir R, Vaishya S, et al. Endoscopic evacuation of septated chronic subdural hemorrhage-Technical considerations, results, and outcome[J]. Surg Neurol Int, 2022, 13: 8. DOI:10.25259/SNI_963_2021.
[3] Onyinzo C, Berlis A, Abel M, et al. Efficacy and mid-term outcome of middle meningeal artery embolization with or without burr hole evacuation for chronic subdural hematoma compared with burr hole evacuation alone[J]. J Neurointerv Surg, 2022, 14(3): 297-300. DOI: 10.1136/neurintsurg-2021-017450.
[4] Bounajem MT, Campbell RA, Denorme F, et al. Paradigms in chronic subdural hematoma pathophysiology: Current treatments and new directions[J]. J Trauma Acute Care Surg, 2021, 91(6): e134-e141. DOI: 10.1097/TA.0000000000003404.
[5] Lin MS. Subdural lesions linking additional intracranial spaces and chronic subdural hematomas: a narrative review with mutual correlation and possible mechanisms behind high recurrence[J]. Diagnostics (Basel), 2023, 13(2): 235. DOI:10.3390/diagnostics1302 0235.
[6] Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor[J]. Geroscience, 2022, 44(3):1353-1371. DOI:10.1007/s11357-022-00570-y.
[7] Kan P, Fiorella D, Dabus G, et al. ARISE I consensus statement on the management of chronic subdural hematoma[J]. Stroke, 2024, 55(5): 1438-1448. DOI:10.1161/STROKEAHA.123.044129.
[8] Huang CJ, Liu X, Zhou XT, et al. Neuroendoscopy-assisted evacuation of chronic subdural hematoma with mixed CT density through a novel small bone flap[J]. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(6): 549-554. DOI:10.1055/s-0040-1715121.
[9] Khan I, Shakir M, Hika B, et al. Failure rates of conservative management of minimally symptomatic chronic subdural hematoma: a systematic review and meta-analysis[J]. World Neurosurg, 2024, 191: 291-302.e1. DOI:10.1016/j.wneu.2024.09.002.
[10]Amano T, Miyamatsu Y, Otsuji R, et al. Efficacy of endoscopic treatment for chronic subdural hematoma surgery[J]. J Clin Neurosci, 2021, 92: 78-84. DOI:10.1016/j.jocn.2021.07.058.
[11]Guo X, Wu L, Ou Y, et al. Postoperative pneumocephalus and recurrence and outcome of chronic subdural hematoma: a systematic review and meta-analysis[J]. Neurosurg Rev, 2022, 46(1): 13. DOI: 10.1007/s10143-022-01925-x.
[12]Hamou H, Alzaiyani M, Rossmann T, et al. Seizure after surgical treatment of chronic subdural hematoma-Associated factors and effect on outcome[J]. Front Neurol, 2022, 13: 977329.DOI:10.3389/fneur. 2022. 977329.
[13]Desir LL, Narayan V, Ellis J, et al. Middle meningeal artery embolization in the management of chronic subdural hematoma: a comprehensive review of current literature[J]. Curr Neurol Neurosci Rep, 2023, 23(4): 109-119. DOI:10.1007/s11910-023-01262-6.
[14]Liu J, Ni W, Zuo Q, et al. Middle meningeal artery embolization for nonacute subdural hematoma[J]. N Engl J Med, 2024, 391(20): 1901-1912. DOI:10.1056/NEJMoa2401201.
[15]Fiorella D, Monteith SJ, Hanel R, et al. Embolization of the middle meningeal artery for chronic subdural hematoma[J]. N Engl J Med, 2025, 392(9): 855-864. DOI:10.1056/NEJMoa2409845.
[16]Davies JM, Knopman J, Mokin M, et al. Adjunctive middle meningeal artery embolization for subdural hematoma[J]. N Engl J Med, 2024, 391(20): 1890-1900. DOI:10.1056/NEJMoa2313472.
[17]Kan P, Maragkos GA, Srivatsan A, et al. Middle meningeal artery embolization for chronic subdural hematoma: a multi-center experience of 154 consecutive embolizations[J]. Neurosurgery, 2021, 88(2): 268-277. DOI:10.1093/neuros/nyaa379.
[18]Aggipothu B, Deepalam S, Badachi S, et al. Middle meningeal artery embolization for the management of chronic subdural hematoma[J]. Cureus, 2023, 15(10): e47293. DOI:10.7759/cureus.47293.
[19]Sila D, Casnati FL, Vojtková M, et al. Middle meningeal artery embolization versus surgery in patients with chronic subdural hematoma-no more fence ditting?[J]. Neurol Int, 2023, 15(4): 1480-1488. DOI:10.3390/neurolint15040096.
[20]Guo C, Zhang X, Hu Z, et al. Middle meningeal artery embolization combined with endoscopic Treatment for chronic subdural hematoma[J]. J Craniofac Surg, 2023, 34(8): 2529-2532. DOI:10.1097/SCS.000 0000000009715.
[21]Huang J, Gao C, Dong J, et al. Drug treatment of chronic subdural hematoma[J]. Expert Opin Pharmacother, 2020, 21(4): 435-444. DOI: 10.1080/14656566.2020.1713095.
PDF(2314 KB)
