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Doostabadi H, Esmaeili F. Comparing Neuroendoscopic and Nonendoscopic Surgical Techniques in Treating Septated Chronic Subdural Hematoma: A Randomized Controlled Trial. Iran J Neurosurg 2025; 11 : 27
URL: http://irjns.org/article-1-483-en.html

Background and Aim: Chronic subdural hematoma (CSDH) usually occurs in the sixth and seventh decades of people’s lives and causes severe permanent complications and even death. Today, the most appropriate treatment for this condition has not been determined. Although spontaneous hematoma absorption has been reported, the best treatment remains surgery. There are different surgical methods for this disease; each has its unique advantages and disadvantages. The present study compared open and endoscopic methods with respect to postoperative neurological symptoms, residual hematoma, recurrence, and operative time.
Methods and Materials/Patients: In this clinical trial, 32 patients were randomly assigned to two groups using the simple random block method: endoscopic and open techniques. This randomized controlled trial compared neuroendoscopic surgery (n=16) with conventional burrhole craniostomy (n=16) in patients with septated CSDH. The patients’ clinical examinations and computed tomography (CT) scans were reviewed, and the necessary information was extracted from their files. For follow-up, patients were contacted by phone 6 months after discharge from the hospital.
Results: After spending a day in the intensive care unit (ICU), all patients were transferred to the ward. The average hospitalization duration and bleeding were significantly lower in the endoscopic group than in the nonendoscopic group (P=0.014). The duration of surgery did not differ significantly between the two groups. The frequency distribution of history of trauma, mortality, and neurological complications in the two groups of nonendoscopic and endoscopic patients was not significantly different from each other (P>0.999, P=0.654, P>0.999, respectively). The recurrence frequency distribution in the endoscopic group was significantly lower than in the nonendoscopic group (P=0.023).
Conclusion: Neuroendoscopic surgery significantly reduced recurrence and hospitalization duration compared to burr-hole craniostomy, with comparable operative times and neurological outcomes.