From burr-hole to embolization: unveiling the evolution of chronic subdural hematoma research (2001-2025)

This study aims to perform a scientometric analysis of global research on chronic subdural hematoma (CSDH) spanning the years 2001 to 2025, with the goal of elucidating publication trends, geographic and institutional contributions, and emerging research frontiers.

We analyzed 2,010 English articles from the Web of Science Core Collection using scientometric tools like CiteSpace, VOSviewer, and Scimago Graphica. Simultaneously, we reviewed clinical trials from PubMed to evaluate clinical progress. The analysis included annual publication counts, country and institution contributions, journal and reference co-citation networks, and keyword co-occurrence and burst detection.

The number of annual publications increased significantly from 40 publications (2000-2009) to 190 publications (2020-2025). The United States (22.4%), China (14.5%), and Japan (13.8%) emerged as the leading contributors. Prominent academic institutions included the University of Cambridge (62 publications), and Harvard University (42 publications). The research trajectory can be categorized into three distinct phases: an initial emphasis on the standardization of surgical procedures, specifically burr-hole drainage; a subsequent phase in the 2010s marked by pharmacological advancements, notably the efficacy of atorvastatin; and a recent focus on minimally invasive techniques, particularly middle meningeal artery embolization (MMAE).

The management of CSDH has evolved towards integrated "drug-intervention-surgery" models, with MMAE and pharmacotherapy representing the forefront of current research. Future research priorities should include the exploration of genomic signatures, the development of biocompatible embolic materials, and the establishment of global multicenter collaborations to enhance precision management strategies.