Application study of endoscopic middle meningeal artery interruption combined with hematoma evacuation for the treatment of chronic subdural hematoma.

To evaluate the feasibility and safety of endoscopic middle meningeal artery (MMA) interruption combined with hematoma evacuation for the treatment of chronic subdural hematoma (CSDH), providing a fundamental basis for the standardized implementation of this new surgical technique and future multicenter studies. A retrospective analysis was conducted on four CSDH patients who underwent this surgical approach between January and April 2025. Preoperatively, 3D reconstruction was used to localize the course of the MMA. Intraoperatively, under endoscopic guidance, the anterior branch of the MMA was interrupted and the hematoma was evacuated. Postoperative neurological recovery and hematoma recurrence were assessed, with follow-up for three months. All four patients successfully underwent surgery, with a mean age of 68.75 years, and no postoperative complications were observed. Postoperative CT scans showed significant reduction of the hematoma, and neurological function gradually improved. No recurrence was detected within three months. The mean operative time was 116.75 min, and the average hospital stay was approximately 15.75 days. Endoscopic MMA interruption combined with hematoma evacuation, preliminarily validated in clinical practice, can be applied to both primary and recurrent CSDH patients. This approach has the potential to overcome the limitations of failed MMA embolization (MMAE) or cases unsuitable for MMAE, and offers a novel strategy for the surgical management of CSDH.