Preoperative Planning for Burr Hole Surgery in Chronic Subdural Hematoma: Visualization of the Superficial Temporal and Middle Meningeal Arteries Using Noncontrast CT

Abstract Recent developments in volume rendering techniques have enabled soft-tissue visualization using noncontrast computed tomography (CT). We aimed to visualize the superficial temporal artery (STA) and middle meningeal artery (MMA) using noncontrast CT to evaluate the technique's usefulness in preoperative planning for chronic subdural hematoma (CSDH). We examined 99 hemispheres of 83 patients with CSDH who underwent burr-hole surgery between August 2019 and May 2023. Of these, 61 hemispheres were preoperatively planned. In the planned group, the STA and MMA were visualized using volume rendering on noncontrast CT scans, and burr-hole positions were planned accordingly to avoid these vessels. This study compared injury rates to the main and secondary branches of the STA and MMA between the planned and nonplanned groups. Postoperative complications including acute intracranial bleeding, subcutaneous hematoma, and CSDH recurrence were investigated. STA injury rate was significantly lower in the planned group than in the nonplanned group (21.3 vs. 42.1%, p = 0.027). Similarly, the MMA injury rate was lower in the planned group than in the nonplanned group (36.1 vs. 55.3%, p = 0.061). No cases of postoperative intracranial bleeding were observed, and hematoma recurrence rate did not significantly differ between the groups. Preoperative evaluation of the STA and MMA using volume rendering from noncontrast CT is technically feasible. This approach may reduce vessel injury, particularly to branches, in burr-hole surgery for CSDH; however, further studies are needed to determine its clinical significance.