Micro-drill craniostomy and perioperative treatment for chronic subdural hematoma: A single-center experience

• This study presents a treatment strategy for chronic subdural hematoma (CSDH) management based on 5 years of institutional experience. • It involves micro-drill craniostomy drainage, perioperative atorvastatin administration, and postoperative urokinase injection, demonstrating favorable outcomes. • Key procedural details include the use of a 2.5 mm Kocher wire for drilling under local anesthesia and continuous hematoma drainage. • The approach yielded no significant postoperative complications and a recurrence rate of 8.6 %. • Multivariate regression analysis identified the absence of postoperative urokinase injection as an independent risk factor for recurrence, highlighting its crucial role in preventing hematoma recurrence. The current research focuses on surgical safety and postoperative recurrence of chronic subdural hematoma (CSDH) treatment. This study proposes a micro-drill craniostomy drainage combined with perioperative treatment. The aim is to describe and validate this treatment approach and explore the risk factors influencing recurrence, to further improve the treatment outcomes for CSDH. A retrospective analysis was conducted on patients who underwent surgery for CSDH from 2018 to 2023. These patients were divided into two groups based on recurrence, and multiple logistic regression analyses were performed to identify the independent factors of postoperative recurrence. Additionally, detailed descriptions of the micro-drill craniostomy drainage surgical technique and perioperative treatment plan were provided. A total of 106 patients with 140 CSDH were treated surgically. All patients experienced varying degrees of improvement in their clinical symptoms. No perioperative deaths or surgical complications occurred. Twelve recurrence cases were observed (8.6 %), 9 of which were managed through conservative treatment. The remaining three cases were treated with the same surgical procedure and urokinase injection, and no recurrence was observed during the last follow-up. After univariate analyses of all the clinical variables, the rate of recurrence was significantly lower in urokinase injection (P = 0.001) and long drainage duration (P = 0.042). Multiple logistic regression analysis identified the absence of postoperative urokinase injection was an independent risk factor for recurrence (odds ratio: 0.011, 95 % confidence interval: 0 – 0.485, P = 0.018), after adjustment for age, anticoagulant therapy, CT density, maximal thickness, pneumocrania, and other risk factors. The combination of micro-drill craniostomy drainage and perioperative atorvastatin treatment is safe and effective for CSDH. It is recommended that urokinase injection as a routine treatment CSDH and further prospective randomized controlled trial is needed to validate its usage details and efficacy.