Neuroendoscopic‐Assisted vs. Conventional Burr‐Hole Drainage for Septated Chronic Subdural Hematoma: A Comparative Cohort Study on Efficacy and Long‐Term Functional Outcomes

Abstract

ABSTRACT Objective Chronic subdural hematoma (CSDH) is prevalent in the elderly. Its septated variant poses a significant surgical challenge, as conventional burr‐hole drainage often yields suboptimal results due to incomplete evacuation. Neuroendoscopy has emerged as a potential solution, but robust comparative evidence is lacking. Methods In this single‐center retrospective cohort study, we enrolled 100 patients with radiologically confirmed septated CSDH. Fifty‐two underwent neuroendoscopic‐assisted evacuation (Endoscopic Group), and 48 underwent conventional burr‐hole drainage (Burr‐Hole Group). We compared intraoperative metrics (operative time, blood loss, irrigation volume, hematoma evacuation rate), drainage duration, recurrence, and neurological/functional outcomes (mRS, NIHSS, ADL, GOS) at 6 months. Results The Endoscopic Group demonstrated a significantly higher hematoma evacuation rate (89.96% vs. 81.64%, p < 0.001) with substantially less irrigation fluid (587 vs. 1538 mL, p < 0.001), despite a longer operative time (68.34 vs. 47.52 min, p < 0.001). The endoscopic approach also led to shorter drainage retention (median 1.0 vs. 2.0 days, p < 0.001) and a significantly reduced recurrence rate (0% vs. 12.5%, p = 0.010). At 6 months, the Endoscopic Group showed superior outcomes, evidenced by more favorable mRS distributions ( p = 0.004), lower NIHSS scores (7.42 vs. 8.26, p = 0.006), higher ADL scores (92.78 vs. 84.45, p < 0.001), and better GOS ratings ( p = 0.014). Overall complication rates were comparable (5.8% vs. 14.6%, p = 0.134). Conclusion Neuroendoscopic‐assisted burr‐hole evacuation is a highly effective strategy with a favorable safety profile for septated CSDH. By ensuring more complete evacuation via direct septal disruption, this technique facilitates faster recovery, significantly lowers recurrence, and improves long‐term functional outcomes, justifying the longer operative time.