The Feasibility of Neuroendoscopic Fenestration in Septated Chronic Subdural Hematoma

We aimed to evaluate the feasibility of neuroendoscopic fenestration (NEF) for the treatment of septated chronic subdural hematoma (scSDH), in comparison with burr hole drainage (BHD) and craniotomy.

A retrospective analysis of 115 scSDH surgeries conducted from 2021 to 2026 at a single institution revealed 71 BHD procedures (61.7%), 34 NEF procedures (29.6%), and 10 craniotomies (8.7%), with NEF performed as either a primary treatment for septations or as a salvage after BHD failure. Outcomes were assessed through volumetric analysis on follow-up computed tomography and recurrence leading to reoperation.

Postoperative hematoma in the NEF group was significantly lower (40.59 ± 47.06 cm3) than that in the BHD (74.07 ± 58.32 cm3, P = .012). The percentage reduction in hematoma was greatest with NEF (-71.74% ± 28.57%) compared with BHD (-44.89% ± 39.66%) and craniotomy (-61.96% ± 46.00%) (P = .003). On univariable analysis, NEF was associated with a significantly lower risk of reoperation compared with BHD (odds ratio [OR], 0.261; 95% CI, 0.082-0.827; P = .022). Multivariable analysis confirmed that smaller postoperative volume (OR, 1.022; 95% CI, 1.011-1.033; P < .001) and greater percentage reduction (OR, 1.033; 95% CI, 1.017-1.050; P < .001) were independent predictors of reduced recurrence, irrespective of the surgical method. NEF demonstrated significantly lower postoperative volume and greater percentage reduction compared with BHD (P = .012 and P = .002, respectively).

NEF showed better hematoma clearance and a lower recurrence rate than BHD, with a similar incision size. It is a viable primary option for scSDH and an appropriate alternative after unsuccessful BHD, without requiring a larger incision.