A retrospective analysis of postoperative recurrence of septated chronic subdural haematoma: endoscopic surgery versus burr hole craniotomy.

OBJECTIVE: To identify the factors associated with Septated chronic subdural haematoma (sCSDH) recurrence and to compare the advantages and disadvantages of burr hole craniotomy (BHC) and endoscopic surgery (ES) with respect to preventing sCSDH recurrence.

METHODS: A total of 76 consecutive patients with sCSDH underwent BHC or ES in our institution. Their clinical data were retrospectively analysed to identify the factors associated with sCSDH recurrence and to evaluate the effectiveness of BHC and ES with respect to preventing sCSDH recurrence.

RESULTS: There were no significant differences in gender, age, Markwalder grade, side of haematoma, preoperative mid-line shifts, intervals, clinical features or medical histories between the two groups. Bilateral sCSDH was the only factor that significantly influenced the sCSDH recurrence rate (RR) (p = 0.001). Male gender, age ≥ 60 years, poor Markwalder grade, preoperative mid-line shifts ≤10 mm, postoperative mid-line shifts >10 mm, neovessels, intervals ≤20 days and medical histories tended to be associated with sCSDH recurrence. The RRs in the BHC and ES groups were 13.7 and 8.7%, respectively. ES eliminated more factors associated with recurrence than BHC; however, ES required more surgery time (p < 0.001) and more medical consumption (p < 0.001) than BHC.

CONCLUSIONS: Bilateral sCSDH exerted the most significant influence on the sCSDH RR. There was no difference between ES and BHC with respect to decreasing the sCSDH RR. However, BHC is a more efficient procedure than ES, as it required less surgery time and less medical consumption than ES.