Management Of cSDH Research Articles

Distribution of the Middle Meningeal Artery Variants in Patients Undergoing Embolization for Chronic Subdural Hematoma

The middle meningeal artery (MMA) is a major dural vessel that plays a significant role in developing chronic subdural hematomas (cSDH). Understanding its variable anatomy is essential for the effective management of cSDH and the prevention of complications. Middle meningeal artery anatomy was retrospectively assessed in a population of 92 patients who underwent digital subtraction angiography of cerebral vessels before middle meningeal artery embolization for chronic subdural hematoma. We assessed 121 middle meningeal arteries in 92 patients who underwent digital subtraction angiography for chronic subdural hematoma treatment from October 2020 to July 2023. The most common type in the extended Adachi classification was IC (19.82%) and the rarest was IB (6.31%). The anterior branch of the MMA was the most frequently dominant, while the most common origin of the posterior branch was observed in the distal segment. We reported 4 cases (3.31%) of the MMA arising from the ophthalmic artery. The most common configuration of MMA was Adachi-type IC. The MMA most often originated from the maxillary artery. The anterior branch of the MMA was typically dominant, and the posterior branch most frequently originated from the distal segment. There was no significant impact of Adachi type on treatment results or fluoroscopy time.

Technical Nuances in the Perioperative Management of Chronic Subdural Hematoma by Twin Burr Hole Craniostomy: Tips, Tricks, and Tactics

AbstractChronic subdural hematoma (CSDH) remains to be the most common neurosurgical entity usually encountered in the elderly population. With an increasing life expectancy and associated comorbidities, the incidence of CSDH is ever increasing. There is a lack of uniformity among neurosurgeons regarding management of CSDH, but surgical evacuation using twin burr hole craniostomy remains to be the most preferred modality. Other options available are twist drill craniostomy and craniotomy. A conservative approach may be preferred in a thin subdural hematoma with no or minimal neurological deficit or in high operative risk patients. Complications such as pneumocephalus, recollection, or rebleeding may be seen following surgical evacuation of CSDH. Herein we aimed to address the technical nuances associated with twin burr hole evacuation of CSDH to reduce the complications and the overall associated morbidity and mortality.

Technical report: Clinical feasibility of augmented reality-navigated chronic subdural hematoma evacuation

Chronic subdural hematoma is an increasingly common pathology for neurosurgeons. Management of chronic Subdural Hematoma (cSDH) poses unique challenges and can be fraught with potential complications. Understanding the spatial relationships of cSDH to adjacent brain tissue and skull topography is critical for successful surgical treatment of this disease. The aim of this report is to highlight the feasibility and efficacy of a novel Augmented Reality (AR) overlay tool for surgical planning with technical description of two surgical cases using AR overlay for surgical management of cSDH. This technical report describes a fiducial-less AR overlay tool for surgical planning of surgical evacuation of cSDH. The AR system was used to superimpose 3D anatomy onto the patients head to provide image guidance during two cases of cSDH evacuation.

Middle meningeal artery embolization associated with reduced chronic subdural hematoma volume and midline shift in the acute postoperative period

BackgroundMiddle meningeal artery (MMA) embolization for endovascular treatment of chronic subdural hematoma (cSDH) is growing in popularity. cSDH volume and midline shift were analyzed in the immediate postoperative window after...

Middle meningeal artery embolization for chronic subdural hematoma: A single-center experience and predictive modeling of outcomes.

Remarkable interest is rising around middle meningeal artery embolization (MMAE) as an emerging alternative therapy for chronic subdural hematoma (cSDH). The study aims to highlight a large center experience and the variables associated with treatment failure and build experimental machine learning (ML) models for outcome prediction. A 2-year experience in MMAE for managing patients with chronic subdural hematoma was analyzed. Descriptive statistical analysis was conducted using imaging and clinical features of the patients and cSDH, which were subsequently used to build predictive models for the procedure outcome. The modeling evaluation metrics were the area under the ROC curve and F1-score. A total of 100 cSDH of 76 patients who underwent MMAE were included with an average follow-up of 6months. The intervention had a per procedure success rate of 92%. Thrombocytopenia had a highly significant association with treatment failure. Two patients suffered a complication related to the procedure. The best performing machine learning models in predicting MMAE failure achieved an ROC-AUC of 70%, and an F1-score of 67%, including all patients with or without surgical intervention prior to embolization, and an ROC-AUC of 82% and an F1-score of 69% when only patients who underwent upfront MMAE were included. MMAE is a safe and minimally invasive procedure with great potential in transforming the management of cSDH and reducing the risk of surgical complications in selected patients. An ML approach with larger sample size might help better predict outcomes and highlight important predictors following MMAE in patients with cSDH.

Abstract 137: Management of cSDH with the Use of 10:1 Glue Hyper‐Dilution in MMA Embolization: Radiographic Follow‐up

Introduction Middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematomas (cSDH) is becoming an alternative to surgical intervention. Recent literature suggests distal embolic penetration beyond visible MMA branches achieves optimal cSDH devascularization. Here, we report the mid‐term radiographic follow‐up of a hyper‐dilution glue technique for enhanced embolization of non‐visible dural vasculature. Methods A prospectively maintained IRB‐approved institutional database of the senior authors was retrospectively reviewed to identify and analyze cSDHs managed with 10:1 glue hyper‐dilution (TRUFILLTM n‐BCA liquid embolic) paradigm. Results Over a 5‐month study period (September 2022 to February 2023), 46 cases of 10:1 glue hyper‐dilution for MMA embolization were identified in 23 patients. 56% of the cases were female with an average age of 70±1.59 years. Average admission cSDH thickness was 9.3±0.8 mm with an average midline shift of 3.5±0.5 mm. Bilateral embolization was performed in 91% (n=21) of patients. Technical success was achieved in all cases without need for periprocedural rescue surgery. One postprocedural complication (2.2%), a unilateral partial facial nerve palsy (House‐Brackmann 2), was identified. All patients were discharged at their mRS baseline. Nine patients (40%) had radiographic follow‐up (mean 42±6.7 days; range 1 to 194 days). Complete resolution of the cSDH was achieved in 67% of those with follow‐up imaging (n=9) cases. In those with residual cSDH, average followup thickness was 7.2±0.8mm. Conclusion Mid‐term radiographic results of 10:1 glue hyper‐dilution for MMA embolization for enhanced non‐visible dural vasculature demonstrates a favorable safety profile compatible with the literature and encouraging resolution of cSDH. Further follow‐up and comparative studies are warranted.

Immunometabolic Profiling of Chronic Subdural Hematoma through Untargeted Mass Spectrometry Analysis: Preliminary Findings of a Novel Approach.

Objective: Metabolomics has growing importance in the research of inflammatory processes. Chronic subdural hematoma (cSDH) is considered to be, at least in part, of inflammatory nature, but no metabolic analyses yet exist. Therefore, a mass spectrometry untargeted metabolic analysis was performed on hematoma samples from patients with cSDH. Methods: A prospective analytical cross-sectional study on the efficacy of subperiosteal drains in cSDH was performed. Newly diagnosed patients had the option of granting permission for the collection of a hematoma sample upon its removal. The samples were analyzed using liquid chromatography-mass spectrometry to obtain different types of metabolites from diverse biochemical classes. The statistical analysis included data cleaning, imputation, and log transformation, followed by PCA, PLS-DA, HCA, and ANOVA. The postoperative course of the disease was followed for 3 months. The metabolite concentrations in the hematoma fluid were compared based on whether a recurrence of the disease was recorded within this time frame. Results: Fifty-nine samples from patients who were operated on because of a cSDH were gathered. Among those, 8 samples were eliminated because of missing metabolites, and only 51 samples were analyzed further. Additionally, 39 samples were from patients who showed no recurrence over the course of a 3-month follow-up, and 12 samples were from a group with later recurrence. We recorded a noticeable drop (35%) in the concentration of acylcarnitines in the "recurrence group", where 10 of the 22 tested metabolites showed a significant reduction (p < 0.05). Furthermore, a noticeable reduction in different Acyl-CoA-dehydrogenases was detected (VLCAD-deficiency p < 0.05, MCAD-deficiency p = 0.07). No further changes were detected between both populations. Conclusions: The current study presents a new approach to the research of cSDH. The measurements presented us with new data, which, to date, are without any reference values. Therefore, it is difficult to interpret the information, and our conclusions should be considered to be only speculative. The results do, however, point in the direction of impaired fatty acid oxidation for cases with later recurrence. As fatty acid oxidation plays an important role in inflammatory energy metabolism, the results suggest that inflammatory processes could be aggravated in cases with recurrence. Because our findings are neither proven through further analyses nor offer an obvious therapy option, their implications would not change everyday practice in the management of cSDH. They do, however, present a further possibility of research that might, in the future, be relevant to the therapy.

Surgical Treatment of Chronic Subdural Hematoma by Single Burr Hole under Local Anesthesia: Outcome of a Prospective Study

Purpose: Surgery is the usual treatment of chronic subdural hematoma: the most commonly used procedure is double burr hole craniostomy under general anesthesia for evacuation of the hematoma. However, there is an alternative technique which is single burr hole under local anesthesia. The purpose behind this study is evaluation of the prognosis of this technique in the management of CSDH according to the cause, clinical presentation, surgical procedure, and outcome.&#x0D; Methodology: In this prospective study, 41 patients with CSDH underwent single burr hole craniostomy under local anesthesia from June, 2022 to May, 2023, at West Erbil Emergency Hospital based on the etiology, clinical picture, surgical procedure, and complications. We excluded some cases from our study: age less than 20 years, uncooperative patients, and multilocular hematomas.&#x0D; Findings: Patients were from 20 to 85 years of age and the mean age was 65 years. Among them, 24 (58.5%) were males and 17 (41.4%) were females. Previous trauma was the major cause of CSDH in 27 (65.8%) followed by coagulopathy in in 7 (17%), anticoagulant or antiplatelet drugs in 5 (12%) and ICP hypotension in 2 (4%). Contralateral weakness was the most common presentation in 23 (56%), headache in 16 (39%) disturbance in level of consciousness in 10 (24.3%), and convulsion in 6 (14%).

Middle Meningeal Artery Embolization in the Management of Chronic Subdural Hematoma: a Comprehensive Review of Current Literature

Chronic subdural hematoma (cSDH) is a common intracranial hemorrhagic disorder with a high incidence rate among the elderly. While small, asymptomatic cSDH may resolve spontaneously, surgical intervention has been the treatment of choice for larger, symptomatic cases. Surgical evacuation of cSDH may be associated with high rates of recurrence, and even asymptomatic cSDH cases tend to progress. Over the last few years, middle meningeal artery (MMA) embolization has proven to be a safe non-invasive treatment of choice with favorable outcomes and a low recurrence rate. The ensuing paper discusses current treatment modalities for cSDH and reviews existing literature on the anatomy of MMA and its embolization as a treatment option for cSDH. Recent studies show that traumatic head injury leading to subdural hemorrhage can induce neovascularization that may initiate a cycle of recurrent subdural hematoma. Distal branches of MMA supply blood to the dural layers. Several studies have revealed that embolization of the MMA can stop the neovascularization process and blood flow. In addition, patients who underwent MMA embolization had a significantly quicker brain re-expansion and lower recurrence rate. Although the management of cSDH is still very much a dilemma, recent research findings bring MMA embolization to light as a promising treatment alternative and adjunctive therapy.

Abstract Number ‐ 102: Middle Meningeal Artery Embolization Failure Profile: A Single Institution Retrospective Study

Introduction Middle Meningeal Artery (MMA) embolization has emerged as a qualitative treatment option for subdural hematomas (SDH). Multiple studies have compared MMA embolization to other alternatives, namely surgery, and conservative treatment, with some indicating that MMA embolization was as effective and safe as the other two options. This study aimed to identify predictors of failures in SDH patients undergoing an MMA embolization. Methods We retrospectively reviewed 52 patients receiving MMA embolization for subdural hematoma management at our institution from 2020 until July 5, 2022 either as primary or adjunctive management. Patients who were under the age of 18 were excluded. Our definition of failure was any MMA embolization requiring an additional surgical procedure to evacuate the hematoma or relieve persistent symptoms. Results 52 patients with mean age of 71±14 and male gender 36 (69.2%) were reviewed. Most common presenting symptom was headache27 (51.9%) followed by gait instability22 (42.3%).35 out of 52 patients underwent MMA embolization as primary management of chronic subdural hematoma without prior surgical treatment. Six out of the 35 patients (17.1%) required a rescue surgical treatment due to increased hematoma size or recurrence of symptoms. Our early trend shows that half of the patients whose MMA embolization failed had a possible onset of SDH between 2 to 4 weeks prior the embolization. This trend is similar to Khorasanizadeh et al. description in which they concluded that late‐stage SDH was more predicated to have a failure of MMA embolization compared to early‐stage SDH (1). Of the remaining three patients, one was diagnosed with metastatic prostate cancer to the bones and kidney. This patient passed away 12 days after the procedure despite a craniotomy post‐embolization. Conclusions More clinical trials are needed to further establish MMA embolization as standard of care in the management of cSDH in a subset profile of patients with higher success rates.

Abstract Number ‐ 106: Particle Versus Liquid Embolic Materials in Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Introduction Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses with a high recurrence rate in the aging population. The primary pathologic process is repeated micro bleeding from fragile neo‐vessels supplied by peripheral branches of the middle meningeal artery (MMA). MMA embolization is an efficacious minimally invasive neuroendovascular technique for the management of chronic subdural hematoma. It has demonstrated reduced incidence of re‐bleeding and recurrence of cSDH in elderly patients. Particle and liquid embolic materials are commonly used to devascularize the MMA however studies comparing the safety and outcomes between these two materials are limited. Our objective was to perform a descriptive analysis to investigate differences and outcomes among two most frequently employed materials for MMA embolization. Methods We performed a single center retrospective review of patients ≥ 18 years who had MMA embolization for cSDH between July 2020 and May 2022. The primary safety, radiation dosage, fluoroscopy time, radiographic and clinical outcomes were compared between particle and liquid embolization. A descriptive analysis for continuous and categorical variables was performed using SAS 9.4 version. Results In a cohort of 116, 48 (41.38%) were treated with liquid embolic material and 68 (58.62%) were treated with particle. The median age of the cohort was 73 years in particle group and 73.5 years in liquid embolic group. There was no significant difference in radiation dose or duration among both groups. There was no reported mortality associated to procedure. One patient experienced non‐disabling ischemic stroke in the particle group. Based on imaging follow‐up, three patients in particle group and one in liquid embolic group had asymptomatic recurrence. One patient in each group had symptomatic recurrence requiring hematoma evacuation. Index median size of hematoma was 12 mm in particle group and 11 mm in liquid embolic group. At approximately one month follow up, the median size of hematoma reduced to 6 mm in both groups. Conclusions Our series demonstrates that liquid embolic and particle embolization are equally safe and effective among patients undergoing MMA embolization for management of cSDH.

Multi-Technique Management of Chronic Subdural Hematoma in a Single Patient: A Case Report

Background: Chronic Subdural Hematoma (cSDH) is one of the most everyday neurosurgical conditions. Unfortunately, there is no defined gold standard technique in managing cSDH, as studies show mixed results with no consensus on the superiority of a particular method. This lack of uniformity in the treatment of cSDH makes the management choice dependent on the clinical symptomatology, surgeon’s preference, and recurrence after a prior intervention.&#x0D; Different management approaches are available, ranging from novel medical therapy, e.g., steroids, etizolam, tranexamic acid, angiotensin-converting enzymes inhibitors (ACEIs), to minimally invasive techniques, e.g., endovascular middle meningeal artery (MMA) embolization and endoscopic treatment, to more invasive surgical approaches, e.g., twist drill craniostomy, burr hole craniostomy, and craniotomy.&#x0D; A component network meta-analysis by Jack et al. showed a 10.8% recurrence rate (95% CI 10.2-11.5) across 418 studies involving different management techniques. The use of a post-operative drain and MMA embolization reduced recurrence, while the risk of morbidity was equivalent across surgical treatments.&#x0D; We aim to present the multi-technique management approaches required to achieve clinical and radiological resolution in a cSDH patient.&#x0D; The Case: We report the clinical course and management of a 47-year-old male with no history of trauma who presented with sudden onset of severe headaches and brain computed tomography scan finding of bilateral cSDH. He required multiple treatment techniques, starting with bilateral twist drill craniostomies and Jackson-Pratt drain insertion with the resolution of the right collection and recurrence of the left collection. He further required the placement of two left burr hole craniostomies for drainage. However, the collection recurred. He then proceeded to have a left middle meningeal artery embolization and a left craniotomy before a clinical and radiological resolution was achieved.&#x0D; Conclusion: The management of cSDH is still an art and not a cookbook. Familiarity of clinicians with multiple techniques and selection based on clinical judgment is essential for improved outcomes. Appropriate patient selection for the right technique will depend on accumulating data from clinical practice and its analysis.

Outcomes of Particle versus Liquid Embolic Materials Used in Middle Meningeal Artery Embolization for the Treatment of Chronic Subdural Hematoma

Early evidence suggests that middle meningeal artery (MMA) embolization is an efficacious minimally invasive neuroendovascular technique for the management of chronic subdural hematoma (cSDH). Particle and liquid embolic materials are commonly used to embolize the MMA; however, studies comparing the safety and outcomes between these 2 materials are limited. Patients ≥18 years old who had MMA embolization for cSDH between July 15, 2020 and May 1, 2022 were retrospectively identified from a single-center database. The primary safety, radiation dosage, fluoroscopy time, and radiographic and clinical outcomes were compared between particle and liquid embolization. In a cohort of 116, 48 (41.38%) were treated with liquid embolic material and 68 (58.62%) were treated with particle. The median age of the cohort was 73 years in the particle group and 73.5 years in the liquid embolic group. There was no significant difference in radiation dose or duration among both groups. There was no reported mortality associated with the procedure. One patient experienced nondisabling ischemic stroke in the particle group. Based on imaging follow-up, 3 patients in the particle group and 1 in the liquid embolic group had asymptomatic recurrence. One patient in each group had symptomatic recurrence requiring hematoma evacuation. The index median size of hematoma was 12 mm in the particle group and 11 mm in the liquid embolic group. At approximately 1 month follow-up, the median size of hematoma reduced to 6 mm in both groups. Our series shows that liquid embolic and particle embolization are equally safe and effective among patients undergoing MMA embolization for management of cSDH.

Clinical and Radiological Characteristics for Recurrence of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.

Chronic subdural hematoma (cSDH) is one of the most studied clinical entities in the neurosurgical literature. Management of cSDH is complicated by its propensity to recurrence. Various factors for the development of recurrence of cSDH have been described in various clinical, epidemiological, and observational studies, yet the evidence available is limited. A systematic review and meta-analysis as per PRISMA guidelines to identify clinical and radiological factors which can predict the development of recurrence in cSDH. A total of 14 studies were included for the systematic review and meta-analysis after a comprehensive search of the online databases. Eight studies were of high methodological quality. Age, use of anticoagulants, obesity, seizure, and liver disease were found to be statistically significant clinical risk factors for the development of recurrence in cSDH. Among the radiological parameters, the internal structure of the hematoma and the width of the hematoma was found to be significant risk factor predicting the development of recurrence. Age >75 years, use of anticoagulation therapy, liver disease, and obesity were significant risk factors for cSDH recurrence. Pneumocephalus, internal architecture of hematoma, bilateral cSDH, the width of hematoma, and the presence of bilateral cSDH are important radiological parameters of the development of recurrent cSDH

Recent Advances and Future Directions in Middle Meningeal Artery Embolization for Chronic Subdural Hematomas.

The purpose of this review is to present a brief background on chronic subdural hematomas (cSDH), middle meningeal artery (MMA) embolization, and its role in decreasing recurrence of cSDH. A review of the most up-to-date literature should demonstrate the efficacy of this procedure. The latest data shows that MMA embolization is a safe procedure, with low complication rates and low recurrence rates. While cSDH managed with surgical evacuation can have a recurrence rate upwards of 30%, MMA embolization alone or as an adjunct to surgery decreases recurrence to less than 5% in most studies. MMA embolization can be especially useful in high-risk populations such as the elderly, patients on anti-platelet medication, and those with coagulopathies. It can also be done awake, done without general anesthesia, and is significantly less invasive than traditional surgical techniques. In reviewing the literature on MMA embolization, it is clear that there are numerous retrospective studies and systematic reviews demonstrating its safety and efficacy, and some prospective dual-arm studies that present novel information. The numerous clinical trials that are currently underway should help to further establish MMA embolization as standard of care in the management of cSDH.

Assessing the Impact of Sustainability on Fund Flows: An Excess Information Approach and US-Based Case Study

Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses in adults. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. We review the potential role for the endovascular management of cSDH within the context of a discussion of the epidemiology, pathophysiology, and conventional management of this disease.

P.157 Adjunctive treatment of chronic subdural hematoma with middle meningeal artery embolization – is the left side more common?

Background: Embolization of middle meningeal artery (EMMA) is an emerging treatment for CSDH and a method to decrease CSDH recurrence. We report a single Canadian center experience of EMMA for the management of CSDH. Methods: Consecutive EMMA patients during the period July 2020 to September 2021 were retrospectively included in this series. EMMA procedures were performed using polyvinyl alcohol particles or liquid embolic agent. All patients were followed clinically and radiographically as per standard of care. Results: A total of 20 patients CSDH (mean 65.6 years; range 14-85 yrs; male 16) underwent 20 EMMA procedures. CSDH occured on the left in 13 patients, right in 4 patients and bilateral in 3 patients. No patients had periprocedural complications. There was no recurrence of CSDH on the EMMA treated side. The mean SDH size decreased from 18.4 +/- 6.34 mm at the time of presentation to 5.31 +/ 3.84 mm at last follow up. The proportion of patients with an mRS of 2 or less increased from 65% to 76%. Conclusions: EMMA was found to be effective and safe in the management of CSDH with no evidence of recurrence on the treated side. Left sided hematomas appear to be more common that right sided hematomas.

Burr hole craniostomy versus minicraniotomy in chronic subdural hematoma: a comparative cohort study

BackgroundChronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. In surgical management of CSDH, there is a lack of standardized guidelines concerning surgical techniques and a lack of consensus on which technique(s) are optimal. Neurosurgical centers have shown a wide variation in surgical techniques. The purpose of this study was to compare two different surgical techniques, one burr hole craniostomy with an active subgaleal drain (BHC) and minicraniotomy with a passive subdural drain (MC).MethodsWe conducted a multicenter retrospective cohort study at two neurosurgical centers in Sweden which included patients with unilateral CSDHs that received surgical treatment with either BHC or MC. The primary outcomes in comparison of the techniques were 30-day mortality, recurrence rate, and complications according to the Landriel Ibañez grading system for complications.ResultsA total of 1003 patients were included in this study. The BHC subgroup included 560 patients, and the MC subgroup included 443 patients. A 30-day mortality when comparing BHC (2.3%) and MC (2.7%) was similar (p = 0.701). Comparing recurrence rate for BHC (8.9%) and MC (10.8%) showed no significant difference (p = 0.336). We found that medical complications were significantly more common in the MC group (p = 0.001). Surgical complications (type IIb) was also associated with the MC group (n = 10, p = 0.003). Out of the 10 patients with type IIb complications in the MC group, 8 had postoperative acute subdural hematomas.ConclusionsBHC was comparable to MC concerning 30-day mortality rate and recurrence rates. We did, however, find that MC was significantly associated with medical complications and serious surgical postoperative complications.

Embolization of the middle meningeal artery for the treatment of chronic subdural hematoma: considerations for pragmatic trial design

Chronic subdural hematoma (cSDH) is a common neurological disease which is increasing in prevalence with an estimated 60 000 new diagnoses of cSDH per year expected by 2030.1 ,2 Embolization...

Subdural open drains as an effective and low-cost modality for the treatment of chronic subdural hematomas

Purpose We present a series that describes the presenting features and clinical outcomes in patients with CSDH treated with a standardised technique and an open-drain placement. Methods We reviewed the medical records of 155 consecutive patients at a single centre who underwent CSDH evacuation by placing burr holes, accompanied by intraoperative irrigation and a subdural Penrose drain between 2014 and 2018. Results The mean age was 65.9 years, 81.9% were males. The most common clinical characteristics were an altered mental state (21.9%) and headache (12.9%). It was necessary to perform a second surgical intervention due to the evidence in the postoperative tomography of a residual hematoma in 10.3% of the cases; there were 2 cases of recurrence in 6 months (1.3%). Pneumonia (6.5%) and seizures (5.8%) were the most frequent medical complications. Intracranial infections accounted for 1.9%, and the mortality rate was 6.4% of cases. Conclusions We provided our experience with a low-cost and less-commonly used technique in the management of CSDH. This technique showed similar recurrence, mortality and intracranial infection rates to those reported in the literature for closed drainage systems. Additional studies will be required to assess this technique.