Middle Meningeal Artery Embolization for the Treatment of Bilateral Chronic Subdural Hematoma

Middle Meningeal Artery Embolization in Chronic Subdural Hematoma in Post Shunted Normal Pressure Hydrocephalus

BACKGROUND

Shunted hydrocephalus patients are at an inherent risk of developing chronic subdural hematomas (cSDHs) from overdrainage. The preliminary results of three much-anticipated clinical trials (STEM, EMBOLISE, MAGIC-MT) have recently been presented, showing efficacy of middle meningeal artery embolization (MMA-E) in reducing observational failure and the need for reoperation in non-shunted patients, but the effect of this procedure in shunted patients remains to be further investigated. In this series, we present our institution's experience with MMA-E in shunted normal pressure hydrocephalus patients in comparison to standard of care (=SOC).

METHODS

We compared nine patients with normal pressure hydrocephalus, ventriculoperitoneal shunt, and shunt-induced cSDHs receiving SOC, shunt adjustment with or without burr hole drainage, to seven patients receiving SOC with MMA-E. Hematoma size and age of patients were matched. Patients were followed with serial head computed tomography scans. Symptoms, hematoma size, time to resolution, resolution status, and embolization details were monitored.

RESULTS

Six of seven SDH patients receiving MMA-E resolved. One patient showed residual but stable 3 mm cSDH after reinitiation of hydrocephalus treatment. The median time to resolution was 139.5 and 89 days for SOC without and with surgery, and 309 or 88 days for SOC without and with surgery plus MMA-E. One MMA-E patient was lost to follow-up and presented more than one year later with decreasing SDH that resolved by post-MMA-E day 504.

CONCLUSIONS

MMA-E in shunt-induced cSDHs has not shown increased resolution speed compared to SOC and liberal use of MMA-E on this cohort may need to be further investigated.

Endovascular Embolization for Chronic Subdural Hematomas: A Literature Review of the Current Evidence

Chronic subdural hematoma (cSDH) primarily affects elderly patients along with those who have multiple health problems, while it develops when blood collects between the dura mater and the brain. The condition results in substantial disability while also causing surgical treatment failures in certain cases. The occurrence of cSDH becomes more frequent as people age beyond 65 years old, which establishes this condition as a major health issue. The standard surgical evacuation method for treating this condition shows limited success because patients experience frequent recurrences, which motivates researchers to study endovascular embolization as an alternative treatment option. The promising endovascular embolization technique uses middle meningeal artery (MMA) embolization to target the blood supply of the neo-membrane surrounding the hematoma, thus preventing rebleeding and reducing recurrence. The available data shows that embolization of the MMA leads to better recurrence prevention than conventional surgical procedures among patients who face restrictions for surgery because of multiple health issues. The review analyzes current research about MMA embolization safety together with its effectiveness and appropriate applications for cSDH treatment. The existing evidence about endovascular embolization as adjunctive therapy to surgical procedures such as burr hole drainage or craniotomy provides a significant impact over standalone treatment for complex and recurrent cSDH cases, reducing recurrence, rescue rates, and complications. However, endovascular embolization also shows better clinical outcomes in reducing these outcomes, but for less complex cSDH cases. There is unclear or inconclusive evidence for overall cSDH patients because current research lacks large multicenter randomized controlled studies together with stringent quality standards and contains various patient groups and minimal study durations. The procedure's effectiveness remains unclear because researchers have not determined the best patient selection criteria, the most suitable embolic agent, or the most economical approach.

Complications of Middle Meningeal Artery Embolization: A Systematic Review and Meta-Analysis

BACKGROUND

Middle meningeal artery embolization (MMAE) is an established treatment option for chronic subdural hematoma. The aim of this systematic review and meta-analysis was to establish estimates of the pooled incidence for complications following MMAE.

METHODS

PubMed, Embase, and Cochrane were searched for studies reporting complications following MMAE through January 2023. A random effects model was used to calculate the pooled incidence of complications stratified based on whether studies excluded patients with comorbidities. Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed.

RESULTS

A final 34 studies containing 921 patients undergoing MMAE were included that reported 35 complications. Neurological complications were reported in 7 studies with an overall pooled incidence of 3.8% (95% confidence interval [CI]: 2.6%-5.5%). Across these studies, there was a pooled incidence of 4.9% (95% CI: 2.9%-8.0%), 3.0% (95% CI: 1.7%-5.3%), and 2.1% (95% CI: 0.4%-9.7%) in studies that did not exclude, did not mention, or excluded patients with comorbidities, respectively. Similarly, 7 studies reported cardiovascular complications with an overall pooled incidence of 3.6% (95% CI: 2.4%-5.4%), 4 studies reported infectious complications with an overall pooled incidence of 2.9% (95% CI: 1.9%-4.5%), and 3 studies reported for miscellaneous complications with an overall pooled incidence of 3.1% (95% CI: 2.0%-4.8%). Further subgroup analysis revealed the pooled incidence of cardiovascular complications was 3.2% (95% CI: 1.7%-6.1%) in studies that did not exclude patients with comorbidities, 4.1% (95% CI: 2.3%-7.1%) in studies that did not specify the exclusion of such patients, and 1.8% (95% CI: 0.2%-11.5%) in studies that excluded these patients. Similarly, the incidence of infectious complications was 3.3% (95% CI: 1.7%-6.2%), 2.7% (95% CI: 1.5%-5.0%), and 1.8% (95% CI: 0.2%-11.5%) across these groups, respectively. Miscellaneous complications were reported at 4.0% (95% CI: 2.2%-7.2%), 2.3% (95% CI: 1.1%-4.6%), and 3.1% (95% CI: 0.9%-10.1%), respectively.

CONCLUSIONS

The published literature suggests that MMAE is a generally well-tolerated procedure with a low risk of significant complications.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Bibliometric Analysis

BACKGROUND

Middle meningeal artery embolization (MMAE) is an endovascular technique that has been rapidly adopted in the management of chronic subdural hematoma (cSDH), with numerous positive results across the literature. This study aimed to summarize the body of original research published on MMAE for the treatment of cSDH through bibliometric methods.

METHODS

The Web of Science, Science Citation Index Expanded database was queried on October 1, 2024 for articles related to MMAE for cSDH. The title, abstract, authors, publication year, journal, keywords, institution of first author, author keywords, and citations of studies were extracted for bibliometric analysis. Bibliometric visualizations were performed using VOSviewer version 1.6.20 and other visualizations were made in Graphpad Prism version 9.4.0. Overlay visualizations depicting average year of article output were selectively constructed to further elucidate trends in authorship.

RESULTS

The study retrieved 198 publications on MMAE to be included in analysis. There was an exponential increase in both the number of published studies and the number of citations over the timeframe. The author, country, institution, and journal that contributed the most to the field were Christopher S. Ogilvy, the United States, Harvard Medical School, and WORLD NEUROSURGERY, respectively. The most recent groupings on keyword analysis as of 2023 include "subdural," "liquid embolic material," "embolic," and "hemorrhage".

CONCLUSIONS

As the popularity of MMAE and power of studies related to the technique continues to rise, we hope that this analysis can continue to guide clinicians and researchers on growing areas of interest and academic hotspots of collaboration.

Bilateral middle meningeal artery embolization for the treatment of bilateral chronic subdural hematoma

OBJECTIVE

Middle meningeal artery embolization (MMAE) is a treatment strategy increasingly used in the management of chronic subdural hematoma (CSDH). While frequently performed for the treatment of bilateral chronic subdural hematoma (bCSDH), outcomes of bilateral MMAE (bMMAE) have not often been independently reported in the literature. In this study, we document the outcomes and utility of bMMAE for the treatment of bCSDH at our institution.

METHODS

This is a retrospective cohort study of patients who underwent bMMAE at our institution between 2018 and 2024. Demographic, clinical, and outcome variables were compared using standard statistical approaches between reoperation and non-reoperation groups, and resolution and non-resolution groups.

RESULTS

Twenty-eight patients underwent bMMAE for the treatment of CSDH. The median age was 75 years. Median radiographic follow-up was 8.0 months. At the time of last-follow-up, radiographic bilateral CSDH resolution was observed in 5 patients (17.9 %) and 10 patients (35.7 %) continued to have symptoms at last follow-up. Reoperation occurred in 5 patients (17.9 %). On univariate comparison between reoperation and non-reoperation cases, patients in the reoperation cohort were more likely to have persistent symptoms at last follow-up (80.0 % versus 26.1 %, p = 0.0410) and had a larger median pre-operative thickness (19.0 versus 13.0, p = 0.0498). There were no significant differences in outcome variables between resolution and non-resolution cases of bMMAE.

CONCLUSIONS

bMMAE is a promising technique for the management of bCSDH with and without concomitant surgical evacuation. Further work is required for proper patient identification for bCSDH treatment options.

Middle meningeal artery embolization with standalone or adjunctive coiling for treatment of chronic subdural hematoma: Systematic review and meta-analysis

INTRODUCTION

Middle meningeal artery embolization (MMAe) is increasingly utilized as a primary or secondary treatment for chronic subdural hematoma (cSDH) and is usually performed with liquid embolics or particles. Outcomes after MMAe with coiling as a standalone treatment, or an adjunct to other agents, have not been reviewed.

METHODS

A systematic review of the literature was performed to identify all original research that included patients who underwent standalone or adjunctive coiling for MMAe. The primary outcome was the need for rescue treatment defined as any unplanned reintervention for recurrent or residual cSDH.

RESULTS

A total of 10 studies comprising 346 patients (mean age 73 years, 39% female) who underwent MMAe with coils were included. The majority of embolizations were with coils and particles (n = 176), followed by standalone coiling (137) and coiling with liquid embolics (120). The pooled rate of rescue treatment after embolization was 9.4% (95% CI 6.4-13.6, I2 = 0). The pooled complication rate was 2.6% (95% CI 1.3-5.1, I2 = 0). In the subgroup analysis of four studies reporting results after standalone coiling, the pooled rescue treatment rate was 8.2% (95% CI 4.0-15.9, I2 = 0) and there were no complications.

CONCLUSION

MMAe with coils is safe and potentially effective, but additional studies evaluating long-term clinical and radiographic results after standalone coiling are needed.

One-Stage Burr Hole Surgery and Middle Meningeal Arterial Embolization for Treating Chronic Subdural Hematoma in a Hybrid Operative Angiography Suite

BACKGROUND

Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition that is known to recur and that leads to unfavorable clinical outcomes. Middle meningeal artery embolization (MMAE) has emerged as an alternative treatment to prevent recurrence. This study investigated the efficacy of combined 2 therapies in a hybrid operative suite for high-risk patients.

METHODS

This retrospective review provides evidence for the indications and benefits of one-stage combined therapy in a hybrid neurovascular operative suite. The procedures include burr hole craniostomy, irrigation, and drainage followed by adjuvant MMAE at the lesion site. Subsequently, routine cone beam computed tomography is conducted after the whole process.

RESULTS

Five patients with symptomatic CSDH and mass effect were enrolled in this study. Among them, 3 patients had undergone burr hole surgery previously but experienced hematoma recurrence. Two patients presented with a history of recent cardiac stent placement due to coronary artery disease, precluding the cessation of antiplatelet or anticoagulant therapy. All patients experienced symptom resolution and demonstrated no evidence of CSDH recurrence during the follow-up period.

CONCLUSIONS

In our initial case experiences, one-stage burr hole surgery and adjuvant MMAE for treating chronic subdural hematoma in a hybrid operative angiography suite could be a feasible and effective treatment modality.

Transradial versus transfemoral access for middle meningeal artery embolization: Choice of the access route considering delirium in the elderly

Background

Treatment of chronic subdural hematoma (CSDH) with middle meningeal artery embolization (MMAE) is becoming well established. Transradial artery access (TRA) is considered less invasive than transfemoral artery access (TFA) and is increasingly indicated in the field of endovascular therapy. Therefore, this study focused on postoperative delirium and compared access routes.

Methods

This is a single-center and retrospective study. The strategy was to perform MMAE for CSDH with symptomatic recurrence at our hospital. Cases from July 2018 to September 2022, when MMAE was introduced in our hospital, were included in this study. Patients were divided into TRA and TFA groups and were compared descriptively for patient background, procedure duration, and incidence of postoperative delirium.

Results

Twenty-five patients underwent MMAE, of whom 12 (48%) were treated with TRA. The overall median age was 82 years, with no clear differences between the TRA and TFA groups in the presence or absence of preexisting dementia or antithrombotic therapy. Delirium requiring medication tended to be lower in the TRA group: 2/12 (16.7%) in the TRA group versus 6/13 (46.2%) in the TFA group, and the mean procedure time for patients undergoing bilateral MMAE was 151 min (interquartile range [IQR]: 140-173 min) in the TRA group versus 174 min (IQR: 137-205 min) in the TFA group.

Conclusion

TRA was associated with an overall shorter procedure time than TFA. MMAE through TRA tended to have a lower incidence of delirium. MMAE through TRA may be useful in recurrent CSDH with a high elderly population.

Middle Meningeal Arterial Embolization Combined With Drilling in the Treatment of Acute Epidural Hematoma

OBJECTIVE

The purpose of this study was to determine the technical feasibility and safety of middle meningeal arterial (MMA) embolization combined with drilling drainage in the treatment of acute epidural hematoma (AEDH) by comparing it with traditional craniotomy in the treatment.

METHODS

One hundred seventeen patients with AEDH treated for MMA embolization combined with drilling and drainage or craniotomy hematoma removal from January 2017 to September 2020 were retrospectively analyzed and divided into a craniotomy group (n=85) and a minimally invasive group (n=32). Hematoma removal was performed in the craniotomy group, and MMA embolization combined with drilling and drainage was performed in the minimally invasive group. The general clinical data, imaging data, surgery, and follow-up of the 2 groups were compared and analyzed.

RESULTS

Compared with the craniotomy group, the residual hematoma volume in the minimally invasive group was higher than in the craniotomy group. The average postoperative drainage duration in the minimally invasive group was longer than in the craniotomy group. Compared with the craniotomy group, the minimally invasive group was associated with shorter operative time, less intraoperative bleeding, and lower rates of postoperative rebleeding. In addition, the incidence of postoperative complications and length of hospitalization in the minimally invasive group were significantly shortened.

CONCLUSION

Middle meningeal arterial embolization combined with drilling and drainage in the treatment of AEDH caused by MMA active bleeding is safe, effective, and more minimally invasive, and can be promoted and applied.

Charlson Comorbidity Index and Frailty as Predictors of Resolution Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

BACKGROUND

Research on variables associated with chronic subdural hematoma (cSDH) resolution following middle meningeal artery embolization (MMAE) is limited. This study investigated the clinical utility of age-adjusted Charlson Comorbidity Index (ACCI) and modified 5-item Frailty Index (mFI - 5) for predicting cSDH resolution following MMAE.

METHODS

We identified patients who underwent MMAE at our institution between January 2018 and December 2022, with at least 20 days of follow-up and one radiographic follow-up study. Patient demographics, characteristics, and outcomes were collected. Complete resolution was defined as absence of subdural collections on CT-scan at last follow-up. Nonage adjusted CCI (CCI), ACCI, and mFI - 5 scores were calculated. Univariate and multivariable logistic regression analyzed the relationship between cSDH resolution and variables. A receiver operating characteristic (ROC) curve established the utility of ACCI and mFI - 5 in predicting hematoma resolution.

RESULTS

The study included 85 MMAE procedures. In univariate analysis, patients without resolution were older, had higher CCI, higher ACCI, higher mFI - 5, and were more likely to have diabetes mellitus. In multivarible analysis, CCI (OR: 0.66, 95% CI: 0.48, 0.91) was independently associated with resolution controlling for age and antithrombotic resumption. The area under the ROC (AUROC) curve was 0.75 (95% CI: 0.65-0.85) for ACCI and 0.64 (95% CI: 0.52-0.76) for mFI - 5. The optimal cutoffs for predicting resolution were ACCI ≥5 (sensitivity = 0.63, specificity = 0.77), and mFI - 5 > 0 (sensitivity = 0.84, specificity = 0.43).

CONCLUSIONS

ACCI and mFI - 5 moderately predict MMAE resolution and may aid in medical decision-making.

General Versus Nongeneral Anesthesia for Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score Matched Study

BACKGROUND AND OBJECTIVES

The choice of anesthesia type (general anesthesia [GA] vs nongeneral anesthesia [non-GA]) in middle meningeal artery embolization (MMAE) procedures for chronic subdural hematomas (cSDH) differs between institutions and left to care team discretion given lack of standard guidelines. We compare the outcomes of GA vs non-GA in MMAE.

METHODS

Consecutive patients receiving MMAE for cSDH at 14 North American centers (2018-2023) were included. Clinical, cSDH characteristics, and technical/clinical outcomes were compared between the GA/non-GA groups. Using propensity score matching (PSM), patients were matched controlling for age, baseline modified Rankin Scale, concurrent/prior surgery, hematoma thickness/midline shift, and baseline antiplatelet/anticoagulation. The primary end points included surgical rescue and radiographic success rates (≥50% reduction in maximum hematoma thickness with minimum 2 weeks of imaging). Secondary end points included technical feasibility, procedural complications, and functional outcomes.

RESULTS

Seven hundred seventy-eight patients (median age 73 years, 73.2% male patients) underwent 956 MMAE procedures, 667 (70.4%) were non-GA and 280 were GA (29.6%). After running 1:3 PSM algorithm, this resulted in 153 and 296 in the GA and non-GA groups, respectively. There were no baseline/procedural differences between the groups except radial access more significantly used in the non-GA group (P = .001). There was no difference between the groups in procedural technical feasibility, complications rate, length of stay, surgical rescue rates, or favorable functional outcome at the last follow-up. Subsequent 1:1 sensitivity PSM retained the same results. Bilateral MMAE procedures were more performed under non-GA group (75.8% vs 67.2%; P = .01); no differences were noted in clinical/radiographic outcomes between bilateral vs unilateral MMAE, except for longer procedure duration in the bilateral group (median 73 minutes [IQR 48.3-100] vs 54 minutes [39-75]; P < .0001). Another PSM analysis comparing GA vs non-GA in patients undergoing stand-alone MMAE retained similar associations.

CONCLUSION

We found no significant differences in radiological improvement/clinical outcomes between GA and non-GA for MMAE.

Automated Preoperative and Postoperative Volume Estimates Risk of Retreatment in Chronic Subdural Hematoma: A Retrospective, Multicenter Study

BACKGROUND AND OBJECTIVES

Several neurosurgical pathologies, ranging from glioblastoma to hemorrhagic stroke, use volume thresholds to guide treatment decisions. For chronic subdural hematoma (cSDH), with a risk of retreatment of 10%-30%, the relationship between preoperative and postoperative cSDH volume and retreatment is not well understood. We investigated the potential link between preoperative and postoperative cSDH volumes and retreatment.

METHODS

We performed a retrospective chart review of patients operated for unilateral cSDH from 4 level 1 trauma centers, February 2009-August 2021. We used a 3-dimensional deep learning, automated segmentation pipeline to calculate preoperative and postoperative cSDH volumes. To identify volume thresholds, we constructed a receiver operating curve with preoperative and postoperative volumes to predict cSDH retreatment rates and selected the threshold with the highest Youden index. Then, we developed a light gradient boosting machine to predict the risk of cSDH recurrence.

RESULTS

We identified 538 patients with unilateral cSDH, of whom 62 (12%) underwent surgical retreatment within 6 months of the index surgery. cSDH retreatment was associated with higher preoperative (122 vs 103 mL; P < .001) and postoperative (62 vs 35 mL; P < .001) volumes. Patients with >140 mL preoperative volume had nearly triple the risk of cSDH recurrence compared with those below 140 mL, while a postoperative volume >46 mL led to an increased risk for retreatment (22% vs 6%; P < .001). On multivariate modeling, our model had an area under the receiver operating curve of 0.76 (95% CI: 0.60-0.93) for predicting retreatment. The most important features were preoperative and postoperative volume, platelet count, and age.

CONCLUSION

Larger preoperative and postoperative cSDH volumes increase the risk of retreatment. Volume thresholds may allow identification of patients at high risk of cSDH retreatment who would benefit from adjunct treatments. Machine learning algorithm can quickly provide accurate estimates of preoperative and postoperative volumes.

Time and Influencing Factors to Chronic Subdural Hematoma Resolution After Middle Meningeal Artery Embolization

OBJECTIVE

We sought to describe the resolution time of chronic subdural hematoma (CSDH) after middle meningeal artery embolization (MMAE) and potential variables that may affect hematoma resolution.

METHODS

A retrospective analysis was performed on CSDH patients between December 2018 and December 2021. Patient characteristics, radiologic manifestations, and data of hematoma resolution were recorded. Univariate and multivariate analyses were conducted to identify predictors of CSDH resolution time.

RESULTS

A total of 53 patients were enrolled including 53 hematomas. Only 1 participant relapsed and did not require surgical evacuation. Hematoma resolution was observed in 27 (50.9%) at 4 months and 48 (90.6%) cases at the last radiologic follow-up. The median MMAE-to-resolution time was 19 weeks (interquartile range: 8-24). The burr-hole irrigation + MMAE group showed faster hematoma resolution than MMAE alone during early follow-up periods, but no significant difference was found at 6 months. Increased thickness of residual hematoma, excessive postoperative midline shift, high-density hematoma, mixed-density hematoma, separated hematoma, and anticoagulant or antiplatelet agents used were predictive of nonresolution at 4 months as determined by univariate analysis, whereas anticoagulant or antiplatelet agents used and high-density hematoma were not significant on multivariate analysis. No significant association was noted between hematoma resolution and comorbidities or other hematoma radiologic features.

CONCLUSIONS

MMAE is an effective and minimally invasive treatment for CSDH with a lower recurrence rate. The median resolution time of CSDH following MMAE was 19 weeks (interquartile range: 8-24). Burr-hole irrigation contributed to early hematoma resolution but had no significant effect at 6 months. In addition, residual hematoma thickness, postoperative midline shift, and specific type of hematoma were associated with delayed hematoma resolution at 4 months.

Middle Meningeal Artery Embolization Combined With Endoscopic Treatment for Chronic Subdural Hematoma

OBJECTIVE

To explore the clinical feasibility of middle meningeal artery (MMA) embolization combined with endoscopic treatment for new or recurrent chronic subdural hematoma (CSDH).

METHODS

Twenty patients with CSDH treated in the Binzhou Medical University Hospital from June 2020 to October 2022 were analyzed retrospectively. The clinical information, prognosis, imaging results, and surgical results of the patients were collected and analyzed. The authors first performed MMA embolization, and then endoscopic treatment of CSDH was performed after successful embolization of MMA. Results: All 20 patients with CSDH were successfully treated with MMA embolization combined with endoscope-assisted evacuation. The symptoms of all patients were relieved, no surgical complications occurred, and no rebleeding and recurrence were found in follow-up computed tomography.

CONCLUSION

Middle meningeal artery embolization combined with endoscopic treatment of CSDH has a good clinical effect, and it may prevent postoperative recurrence.

Middle meningeal artery embolization for chronic subdural hematoma: a systematic review

Background

Chronic subdural hematoma (cSDH) is one of the most common diseases in neurosurgery. Middle meningeal artery embolization (MMAE) is reportedly an option to prevent recurrence or avoid surgery in patients with cSDH. This study was performed to review the evidence on MMAE for cSDH and evaluate its safety, efficacy, indications, and feasibility.

Methods

We systematically reviewed the literature according to the PRISMA guidelines using an electronic database. The search yielded 43 articles involving 2,783 patients who underwent MMAE.

Results

The hematoma resolution, recurrence, and retreatment rates in the MMAE-alone treatment group (n = 815) were 86.7%, 6.3%, and 9.6%, respectively, whereas those in the prophylactic MMAE with combined surgery group (n = 370) were 95.6%, 4.4%, and 3.4%, respectively. The overall MMAE-related complication rate was 2.3%.

Conclusion

This study shows that MMAE alone is, although not immediate, as effective as evacuation surgery alone in reducing hematoma. The study also shows that combined treatment has a lower recurrence rate than evacuation surgery alone. Because MMAE is a safe procedure, it should be considered for patients with cSDH, especially those with a high risk of recurrence.

Surgical Treatment of Bilateral Chronic Subdural Hematoma

Background

Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%-20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH.

Methods

153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate.

Results

All patients underwent CT  examination one day after operation. The CT  imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant.

Conclusions

Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.