Safety and feasibility of transitioning from conventional burr-hole craniostomy to endoscope-assisted evacuation for chronic subdural hematoma: A retrospective cohort study

Objective Although endoscope-assisted evacuation for chronic subdural hematoma (cSDH) may reduce recurrence rates, its adoption has been limited by a procedural learning curve that may affect operative efficiency and clinical outcomes. This study compared conventional burr-hole craniostomy with endoscope-assisted evacuation for symptomatic cSDH and evaluated the challenges of institutional implementation. Methods We retrospectively reviewed patients with symptomatic cSDH treated between 2023 and 2025. Patients in the treatment group underwent endoscopic-assisted hematoma evacuation, while those in the control group received conventional burr-hole craniostomy. Continuous variables were compared using Student’s t-test or Mann-Whitney U test, and categorical variables were analyzed using Fisher’s exact or Chi-square tests. Multivariable logistic regression was performed to identify independent predictors of outcomes, with results reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Statistical significance was defined as a two-tailed p < 0.05. All analyses were conducted using R software. Results A total of 110 patients were included (treatment group, n = 60; control group, n = 50). Patients in the treatment group were older ( p = 0.006), whereas baseline characteristics and clinical presentations were otherwise comparable between groups. Operative time was longer in the treatment group (123.8 ± 45.2 vs. 104.3 ± 42.0 minutes, p = 0.02). No significant differences were observed in postoperative Glasgow Coma Scale scores, modified Rankin Scale scores, complication or recurrence rates, length of hospital stay, or functional recovery. Operative time decreased with increasing surgeon experience in unilateral endoscopic cases, indicating the presence of a learning curve. Conclusion Endoscope-assisted evacuation is a safe and effective alternative to conventional burr-hole craniostomy for cSDH, without increased complications or compromised clinical outcomes during institutional adoption.