Mini-Craniotomy Neuroendoscopic Evacuation Versus Double Burr-Hole Drainage for Septated Chronic Subdural Hematoma:...

To compare radiological efficacy, perioperative safety, and outcomes of mini-craniotomy neuroendoscopic hematoma evacuation (NHE) versus double burr-hole drainage (dBHD) for septated chronic subdural hematoma (sCSDH).

A retrospective cohort of 55 patients (NHE=34, dBHD=21) treated 2020-2025 was enrolled. Baseline demographics, comorbidities and neurological scores (GCS, Markwalder, Barthel ADL) were collected. Postoperative hematoma clearance and midline shift were measured by routine CT. ANCOVA was applied to compare postoperative Barthel ADL scores, adjusting for preoperative ADL and Markwalder grade. Cochran-Armitage test assessed temporal selection bias. Fisher's exact test and Firth logistic regression analyzed recurrence and mortality; sensitivity analyses validated results.

Most baseline indicators were balanced, while preoperative ADL was higher in NHE (61±25 vs 46±25, P=0.06). NHE required longer operation time but achieved better hematoma clearance and midline shift relief (all P<0.05). Postoperative Markwalder grade and Barthel ADL scores were superior in NHE; the ADL difference remained significant after ANCOVA (P=0.001). The overall complication rate was lower in NHE (8.8% vs 33%, P=0.033). Separated analysis of recurrence (2.9% vs 14%, P=0.150) and mortality (2.9% vs 9.5%, P=0.551) showed no intergroup differences. Hospital stay and costs were comparable.

NHE was associated with greater early hematoma clearance, functional recovery and despite longer operation. Recurrence and mortality were numerically lower in NHE without statistical significance; these exploratory findings need large prospective verification.