• Shunsuke Tanoue, Kenichiro Ono, Terushige Toyooka, Masaya Nakagawa, and Kojiro Wada.
• Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan; Department of Neurosurgery, National Defense Medical College Hospital, Tokorozawa, Japan. Electronic address: stanoue@ndmc.ac.jp.
• World Neurosurg. 2024 Dec 1; 192: e119e123e119-e123.

ObjectiveWe assessed the effectiveness of a treatment strategy based on hematoma characteristics and volume.MethodsFrom September 2022 to December 2023 (the Study period), a 2-center retrospective observational study of initial chronic subdural hematoma was performed. The baseline period was from January 2018 to December 2019. Patients were classified into the high and low retreatment rate groups (Groups H and L, respectively). During the Study period, Group H was treated with drainage and middle meningeal artery embolization, while Group L was treated with drainage or middle meningeal artery embolization alone. During the Baseline period, all the patients were treated with drainage alone. The primary and secondary endpoints were group retreatment rates and severe procedure-related complications requiring surgical intervention and permanent sequelae, respectively.ResultsFifty-two patients were included during the Study period (31 in Group H and 21 in Group L) and 53 during the Baseline period (32 in Group H and 21 in Group L). Three (5.8%) and 9 (17.0%) patients required retreatment in the Study and Baseline periods, respectively (P = 0.12). One (3.2%) and 9 (28.1%) patients in Group H required retreatment during the Study and Baseline periods, respectively (P = 0.01). Similarly, 2 patients (9.5%) and no patient in Group L required retreatment during the Study and Baseline periods, respectively (P = 0.49). No severe complications were reported throughout.ConclusionsChronic subdural hematoma treatment strategies that consider to hematoma volume and characteristics have the potential to identify and reduce treatment rates in cases with high retreatment rates.Copyright © 2024 Elsevier Inc. All rights reserved.

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