Endoscopic surgery operation followed with a comprehensive management reduces the recurrence rate and promotes neurological recovery in the treatment of chronic subdural hematoma.

Chronic subdural hematoma (CSDH) is an abnormal, encapsulated accumulation of fluid of complex origin, consisting mostly or completely of liquefied old blood and cerebrospinal fluid (CSF). It typically occurs in the subdural space in older adults following a head injury. Most often, the accumulated fluid exerts pressure on brain tissue, leading to neurological complications. Surgical treatment is the preferred approach for CSDH, especially in cases with significant midline shifts or clinically significant symptoms. Craniotomy, drill-hole craniotomy and twist-drill craniotomy are common surgical techniques used to treat CSDH. However, a recurrence rate of about 2.5–33% is associated with these treatment modalities. Endoscopically assisted removal of CSDHs is a recognized technique but not widely employed. Research on the treatment of chronic subdural hematoma (CSDH) has focused on the potential recurrence after surgery. Here, we propose a new comprehensive treatment approach that includes operation management and postoperative non-invasive training. A prospective study was conducted at our institution. Of 206 middle-aged and elderly CSDH patients who underwent surgically treated subdural drainage, 117 patients were assigned to the traditional treatment group, and 89 patients were assigned to the comprehensive treatment group. The comprehensive method involved endoscopic surgery, with intraoperative negative-pressure suction for non-bubble extraction, and postoperative balloon blowing 6 times per hour for 12 h per day. Efficacy was assessed by hematoma recurrence rate (primary endpoint, follow-up duration ≥ 6 months), with secondary endpoints being recurrence rate at 3-month follow-up and neurological functional improvement at 3-month follow-up.