Modified surgical technique for recurrent organized chronic subdural hematoma: a preliminary retrospective case series.

BACKGROUND

The incidence of chronic subdural hematoma (CSDH) increases with age, and the recurrence rate after burr-hole drainage remains relatively high. The clinical management of recurrent organized CSDH continues to pose a challenge. This study aimed to preliminarily evaluate the safety, neurological improvement, and recurrence control of craniotomy for hematoma evacuation combined with middle meningeal artery occlusion and temporalis muscle grafting in the treatment of recurrent organized CSDH.

METHODS

A retrospective analysis was performed on 17 patients with recurrent organized CSDH admitted between January 2021 and December 2023, all of whom underwent the above modified procedure. Perioperative parameters were recorded. Neurological function before and after surgery was assessed using the Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), Markwalder grading system, and Glasgow Outcome Scale (GOS). Postoperative complications and hematoma recurrence were monitored during follow-up.

RESULTS

Complete hematoma evacuation was achieved in all patients, with improved midline shift and satisfactory brain re-expansion. Neurological function was improved postoperatively, as reflected by optimized GCS, mRS, Markwalder grade, and GOS scores. Postoperative complications occurred in 5 patients (29.41%), including subdural effusion, cerebrospinal fluid leak, secondary intracranial hemorrhage, and epilepsy, all of which resolved with conservative management. No recurrence was observed according to the 90-day postoperative recurrence criteria. No ipsilateral hematoma recurrence or new neurological deficits were noted during 1-year follow-up.

CONCLUSION

In highly selected patients with recurrent organized CSDH, this modified craniotomy technique appears feasible and reasonably safe, with encouraging short-term neurological improvement. No recurrence was observed per the predefined 90-day endpoint; 1-year follow-up was descriptive. This study is a small-sample, single-center, uncontrolled retrospective case series in a highly selected cohort. The results should be interpreted as preliminary safety and feasibility data, and no assertions regarding superior efficacy or recurrence reduction can be made. Large-scale controlled studies are warranted to further validate clinical utility.