Endoscopic-Assisted evacuation vs. burr-hole drainage for chronic subdural hematoma: a retrospective comparative study

Objective This study aimed to compare the perioperative outcomes of endoscopic-assisted evacuation vs. burr-hole drainage methods in the chronic subdural hematoma (CSDH). Methods This retrospective cohort study included consecutive surgical cases of CSDH treated at Shanxi Provincial People's Hospital. After eligibility screening, 40 patients who underwent endoscopic-assisted evacuation and 158 who underwent burr-hole drainage were included in the analysis. Postoperative outcomes were systematically evaluated across intraoperative parameters, clinical and laboratory measures, procedural costs, and length of hospital stay. Results Patients who underwent endoscopic-assisted evacuation had significantly lower residual hematoma rates compared to those who underwent burr-hole drainage (35.00% vs. 54.78%, p = 0.0255). In the multiple regression analysis, the endoscopic group demonstrated improved neurological outcomes compared to the burr-hole group, with an odds ratio of 0.30 (95% CI: 0.12–0.63; p = 0.0021) for achieving a good functional outcome (lower mRS). However, endoscopic-assisted evacuation was associated with longer operative time, averaging 40.12 min longer ( p < 0.0001) and higher hospitalization costs, averaging ¥9,600 more ( p < 0.0001). Occurrence of postoperative complications such as intracranial pneumocephalus and hematoma recurrence were not significantly different between the two groups. Hemoglobin count was lower in the endoscopy group than in the burr-hole group (127.90 ± 14.93 vs. 133.00 ± 14.35 g/L, p = 0.0514) although no anemia-related complications occurred in the endoscopic group. Conclusion Endoscope-assisted evacuation enables more thorough clearance of hematoma and leads to better recovery for patients, without increasing procedural trauma or postoperative complications, though its higher cost may limit accessibility. These findings may help inform surgical decision-making and resource allocation.