Burr hole craniostomy versus minicraniotomy for chronic subdural hematoma: an updated systematic review and meta-analysis

Abstract Background Chronic subdural hematoma (CSHD) is a common neurological disorder, especially in older people and those on anticoagulant therapy, with incidences of 58 per 100,000 and 80 per 100,000 annually in those individuals over 65 and 75 years, respectively. It is caused by tearing of bridging veins after a minor head injury , presenting with signs and symptoms such as headache , gait disturbance , cognitive decline , hemiparesis , and even unconsciousness . The mortality rate for treated CSDH patients is relatively low, (2–5%) but can be significantly higher in older and medically frail patients, especially those with delayed diagnosis and recurrent hematomas. Objective This systematic review and meta-analysis aimed to compare the safety, effectiveness, and perioperative outcomes of burr hole craniostomy [BHC] and minicraniotomy [MC] for the treatment of CSDH. Methods PubMed, Embase, and Cochrane databases were systematically searched via relevant keywords from inception until July 12, 2025. A total of sixteen studies were included after the final screening. Outcomes were reported as the recurrence rate, reoperation rate, operation duration, mortality, postoperative complications, rate of good outcome, etc. Heterogeneity was assessed via I 2 (I > 50%=significant heterogeneity). Statistical calculations were performed via Review Manager 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark), with a p value of < 0.05 indicating statistical significance. Results This meta-analysis included 15 observational studies and 1 RCT with a total of 4352 patients. Compared with MC, BHC was associated with a significantly lower reoperation rate (RR: 0.53, 95% 0.32 to 0.85; P = 0.009) and shorter operation duration (RR: -20.15, 95% CI: -28.99 to -11.31; P < 0.00001). However, there was no statistically significant difference between the groups in terms of the recurrence rate (RR: 0.69, 95% CI: 0.480.99, P = 0.05), mortality rate (RR:1.07, 95% CI: 0.741.54, P = 0.72), rate of good outcomes (RR:1.20, 95% CI: 0.991.46, P = 0.07), postoperative complications (RR:0.68, 95% CI: 0.441.06, P = 0.09), MGS score (RR: -0.02, 95% CI: -0.260.22, P = 0.87) or mark Walder score (RR: 1.06, 95% CI: 0.951.18, P = 0.29). Conclusion CSHD, BHC, and MC offered similar clinical results. BHC, however, has benefits in terms of a shorter operative time and a lower reoperation rate.