| Objective: To compare the clinical efficacy and prognosis of different minimally invasive surgical treatments for chronic subdural hematoma (CSDH). Methods: A retrospective analysis was conducted on 229 CSDH patients treated between January 2019 and December 2024. Patients were divided into CT-guided minimally invasive puncture drainage (n=122) and burr-hole drainage groups (n=107, including 45 endoscopic-assisted and 62 conventional procedures). Baseline characteristics, laboratory results, surgical parameters, imaging findings (preoperative and 48h postoperative), and prognostic indicators were compared. Risk factors for postoperative rebleeding were analyzed. Results: The CT-guided group had higher proportions of patients with midline shift >10mm, intraoperative irrigation, urokinase use, and admission GCS <15. This group also demonstrated shorter operation time, less blood loss, fewer complications (intracranial pneumatosis/effusion), and shorter hospital stays. Hypertension and alcohol history were identified as risk factors for rebleeding. Conclusion: CT-guided puncture drainage, utilizing multiple catheters and urokinase irrigation, offers advantages in reducing operation time and complications, though both techniques showed comparable prognoses. Patients with poorer baseline conditions or severe consciousness impairment may benefit more from CT-guided drainage. Hypertension and alcohol use increase rebleeding risk. |