Hematoma Capsule Spanning the Sylvian Fissure and Non-Blocking the Middle Meningeal Artery During Surgery Are Associated With Postoperative Recurrence of Chronic Subdural Hematoma

Background: Despite advances in surgical techniques, recurrence after chronic subdural hematoma (CSDH) evacuation remains common. With the aging of the population, the incidence rate is still rising. Most patients require surgical treatment, but postoperative hematoma recurrence remains an important factor affecting patient prognosis. Objective: This study aimed to identify factors influencing recurrence following neuroendoscopic-assisted drainage. Methods: CSDH patients who underwent neuroendoscopy-assisted hematoma drainage(NEAHD) via a single burr-hole craniostomy between January 2021 and August 2024 were categorized based on the presence or absence of postoperative hematoma recurrence. Binary logistic regression analysis was performed on the variables that showed statistically significant inter-group differences in univariate analyses. Results: In total, 121 patients with CSDH were included. The recurrence group consisted of 17 patients (14.05%). Gender, age, smoking, alcoholism, hypertension or diabetes, perioperative use of statins, hematoma thickness, midline deviation distance, and direction, depth, and retention time of the drainage tube were not associated with hematoma recurrence. In contrast, hematoma capsule spanning the Sylvian fissure (P < 0.001; OR = 12.504; 95% CI, 3.091-50.583) and non-blocking the main trunk or major branches of the middle meningeal artery (MMA) (P = 0.006; OR = 9.955; 95% CI, 1.911-51.848) were the independent risk factors for hematoma recurrence after NEAHD surgery. Conclusion: Spanning of the hematoma capsule over the Sylvian fissure and absence of intraoperative occlusion of the middle meningeal artery are independent risk factors for recurrence. These features should be considered when planning surgical strategies for CSDH.