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Updated: May 29, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Endoscopic-Assisted evacuation vs. burr-hole drainage for chronic subdural hematoma: a retrospective comparative
Yang Mi1, Chunhong Wang2, Xiaohui Yao2
1The Neurosurgery Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, China.
Insights
Endoscopic-assisted evacuation for chronic subdural hematoma (CSDH) offers better hematoma clearance and improved neurological outcomes compared to burr-hole drainage. While associated with increased costs and operative time, it does not raise complication rates.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Medical Technology
Background:
- Chronic subdural hematoma (CSDH) is a common neurosurgical condition.
- Traditional burr-hole drainage is a standard treatment for CSDH.
- Endoscopic-assisted evacuation presents an alternative surgical approach.
Purpose of the Study:
- To compare the perioperative outcomes of endoscopic-assisted evacuation versus burr-hole drainage for CSDH.
- To evaluate differences in hematoma recurrence, neurological recovery, operative time, and costs.
Main Methods:
- Retrospective cohort study of 40 patients undergoing endoscopic-assisted evacuation and 158 patients undergoing burr-hole drainage for CSDH.
- Systematic evaluation of intraoperative parameters, clinical and laboratory measures, procedural costs, and length of hospital stay.
- Multiple regression analysis to assess factors influencing neurological outcomes.
Main Results:
- Endoscopic evacuation showed significantly lower residual hematoma rates (35.00% vs. 54.78%) and better neurological outcomes (OR 0.30 for good functional outcome).
- Endoscopic procedures had longer operative times (40.12 min longer) and higher hospitalization costs (¥9,600 more).
- No significant differences in postoperative complications like pneumocephalus or recurrence were observed between groups.
Conclusions:
- Endoscopic-assisted evacuation provides more thorough hematoma clearance and better patient recovery for CSDH.
- This method does not increase procedural trauma or postoperative complications compared to burr-hole drainage.
- Higher costs associated with endoscopic evacuation may impact accessibility, necessitating careful consideration for surgical decision-making and resource allocation.
Objective:
This study aimed to compare the perioperative outcomes of endoscopic-assisted evacuation vs. burr-hole drainage methods in the chronic subdural hematoma (CSDH).
Methods:
This retrospective cohort study included consecutive surgical cases of CSDH treated at Shanxi Provincial People's Hospital. After eligibility screening, 40 patients who underwent endoscopic-assisted evacuation and 158 who underwent burr-hole drainage were included in the analysis. Postoperative outcomes were systematically evaluated across intraoperative parameters, clinical and laboratory measures, procedural costs, and length of hospital stay.
Results:
Patients who underwent endoscopic-assisted evacuation had significantly lower residual hematoma rates compared to those who underwent burr-hole drainage (35.00% vs. 54.78%, p = 0.0255). In the multiple regression analysis, the endoscopic group demonstrated improved neurological outcomes compared to the burr-hole group, with an odds ratio of 0.30 (95% CI: 0.12-0.63; p = 0.0021) for achieving a good functional outcome (lower mRS). However, endoscopic-assisted evacuation was associated with longer operative time, averaging 40.12 min longer (p < 0.0001) and higher hospitalization costs, averaging ¥9,600 more (p < 0.0001). Occurrence of postoperative complications such as intracranial pneumocephalus and hematoma recurrence were not significantly different between the two groups. Hemoglobin count was lower in the endoscopy group than in the burr-hole group (127.90 ± 14.93 vs. 133.00 ± 14.35 g/L, p = 0.0514) although no anemia-related complications occurred in the endoscopic group.
Conclusion:
Endoscope-assisted evacuation enables more thorough clearance of hematoma and leads to better recovery for patients, without increasing procedural trauma or postoperative complications, though its higher cost may limit accessibility. These findings may help inform surgical decision-making and resource allocation.