To introduce and evaluate the preliminary safety and feasibility of a 'Triple-Modality' surgical strategy, which includes MMA embolization, neuroendoscopic fenestration, and dexamethasone-saline irrigation, addressing the components of complex septated chronic subdural hematomas.
Key Findings:
The protocol was successfully applied to all 7 patients with a median age of 71 years.
Median radiographic hematoma volume reduction was >95%.
All patients improved to a Markwalder Grade of 0–1 with no recurrences (0/7, 0%) over a median follow-up of 6.5 months.
The historical control cohort experienced a 36.3% recurrence rate (4/11), which was not statistically significant (p = 0.106).
No steroid-related systemic complications, subdural empyemas, or wound healing defects were observed.
Interpretation:
The preliminary results suggest that the triple-modality approach is technically feasible and safe, with promising outcomes in terms of hematoma clearance and recurrence rates.
Limitations:
Small sample size of 7 patients limits generalizability and may not represent broader patient populations.
Retrospective design may introduce bias, affecting the reliability of outcomes.
Larger prospective cohorts are necessary to evaluate the independent efficacy of each modality.
Conclusion:
The study demonstrates the potential of a combined surgical approach for complex CSDHs, warranting further investigation through larger, controlled studies.
