DOI: 10.1227/ons.0000000000002125 ISSN: 2332-4252

The Feasibility of Neuroendoscopic Fenestration in Septated Chronic Subdural Hematoma

Kyoung Chan Kim, Chang Ki Jang, Kwang-Chun Cho, Jae Whan Lee, Yoon Jung Choi, Jun Kyu Hwang
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BACKGROUND AND OBJECTIVES:

We aimed to evaluate the feasibility of neuroendoscopic fenestration (NEF) for the treatment of septated chronic subdural hematoma (scSDH), in comparison with burr hole drainage (BHD) and craniotomy.

METHODS:

A retrospective analysis of 115 scSDH surgeries conducted from 2021 to 2026 at a single institution revealed 71 BHD procedures (61.7%), 34 NEF procedures (29.6%), and 10 craniotomies (8.7%), with NEF performed as either a primary treatment for septations or as a salvage after BHD failure. Outcomes were assessed through volumetric analysis on follow-up computed tomography and recurrence leading to reoperation.

RESULTS:

Postoperative hematoma in the NEF group was significantly lower (40.59 ± 47.06 cm 3 ) than that in the BHD (74.07 ± 58.32 cm 3 , P = .012). The percentage reduction in hematoma was greatest with NEF (−71.74% ± 28.57%) compared with BHD (−44.89% ± 39.66%) and craniotomy (−61.96% ± 46.00%) ( P = .003). On univariable analysis, NEF was associated with a significantly lower risk of reoperation compared with BHD (odds ratio [OR], 0.261; 95% CI, 0.082-0.827; P = .022). Multivariable analysis confirmed that smaller postoperative volume (OR, 1.022; 95% CI, 1.011-1.033; P < .001) and greater percentage reduction (OR, 1.033; 95% CI, 1.017-1.050; P < .001) were independent predictors of reduced recurrence, irrespective of the surgical method. NEF demonstrated significantly lower postoperative volume and greater percentage reduction compared with BHD ( P = .012 and P = .002, respectively).

CONCLUSION:

NEF showed better hematoma clearance and a lower recurrence rate than BHD, with a similar incision size. It is a viable primary option for scSDH and an appropriate alternative after unsuccessful BHD, without requiring a larger incision.

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