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Background: The main surgical interventions for chronic subdural hematoma (CSDH) include craniotomy for hematoma evacuation, neuroendoscopic hematoma evacuation, and burr hole drainage.However, elderly patients often present with significant comorbidities, which limit their ability to tolerate general anesthesia and invasive surgical procedures.Minimally invasive soft-channel drainage under local anesthesia has emerged as a viable alternative, particularly suitable for elderly patients or those with high surgical risk.This study aims to evaluate the clinical outcomes and complication rates of minimally invasive soft-channel drainage assisted by 3D Slicer software for the treatment of CSDH. It also aims to provide new clinical evidence to help improve and optimize treatment protocols for this condition.
Methods: A retrospective analysis was conducted involving 83 patients with CSDH treated in our department between January 2021 and December 2023. Patients were categorized into two groups based on the surgical intervention: the control group (burr-hole drainage, n = 42) and the intervention group (minimally invasive soft-channel drainage, n = 41).Baseline characteristics, anesthesia methods, perioperative metrics, and complications were compared. Clinical outcomes were evaluated using the Barthel Index and the modified Rankin Scale (mRS) preoperatively and three months postoperatively.
Results: The drainage retention duration, operative time, and hospitalization period in the intervention group were significantly reduced compared to the control group, with reduced intraoperative blood loss (all P < 0.05). There was no significant difference in residual hematoma volume between the groups on postoperative day one (P > 0.05). The incidence of postoperative complications, including pulmonary infection, recurrent subdural hemorrhage, cerebrospinal fluid leakage, and intracranial pneumatosis, was significantly lower in the intervention group compared to the control group (all P < 0.05). No intracranial infections were observed in either group, and there was no statistically significant difference in hematoma recurrence rates (P > 0.05). Similarly, no significant differences were observed in the preoperative and three-month postoperative Barthel Index and mRS scores between groups (all P > 0.05). However, both groups demonstrated significant improvement in mRS and Barthel Index scores at three months postoperatively compared to preoperative levels(all P < 0.001).
Conclusion: Both minimally invasive soft-channel drainage assisted by 3D Slicer and burr-hole drainage are safe and effective interventions for CSDH. Nevertheless, the minimally invasive approach provides significant benefits in terms of reducing intraoperative blood loss, shortening operative time, minimizing surgical trauma, and reducing the rate of complications. This approach is only advantageous for patients with well-liquefied hematomas and those with relative contraindications to general anesthesia.
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