Therapeutic effects of neuroendoscopic surgery and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma

Objective To investigate and compare the efficacy of endoscopic-assisted hematoma evacuation and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma (CSDH). Methods A total of 38 patients with septated CSDH who were admitted in Peking Union Medical College Hospital and received endoscopic-assisted hematoma evacuation (endoscopy group, n = 19) or burr hole drainage combined with urokinase (burr hole group, n = 19) from January 2022 to December 2023. The change rate of the hematoma cavity was calculated, the modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate neurological function prognosis and abilities of daily living. In addition, postoperative drainage time, postoperative hospitalization time, total hospitalization cost and incidence of cerebrospinal fluid leakage were recorded. Results The two treatment modalities did not show differences in the change rate of the hematoma cavity (t = 0.858, P = 0.396). Both endoscopy group (Z = - 4.116, P = 0.000) and burr hole group (Z = - 4.195, P = 0.000) had lower mRS scores on discharge than on admission, while the difference between the 2 groups on discharge was not significant (Z = - 0.502, P = 0.616). The endoscopy group (Z = - 1.557, P = 0.119) and burr hole group (Z = - 0.091, P = 0.928) had no significant difference in BI scores on discharge versus on admission, and the difference in BI scores between the 2 groups on discharge was also not statistically significant (Z = - 0.853, P = 0.394). Postoperative drainage time was longer in the endoscopy group (t = - 2.488, P = 0.018), but postoperative hospitalization time was longer in the burr hole group (t = - 3.894, P = 0.000). Total hospitalization cost in both 2 groups (t = 1.175, P = 0.248) and the incidence of cerebrospinal fluid leakage (Fisher's exact probability: P = 0.313) were not statistically significant. Conclusions Both neuroendoscopic surgery and burr hole drainage combined with urokinase treatment are safe and effective in treating septated CSDH. They can clear the hematoma and improve neurological function; neuroendoscopic surgery can faster improve the neurological function and shorter postoperative hospitalization time.