Comparison of endovascular and microsurgical treatment in patients with aneurysmal subarachnoid hemorrhage requiring external ventricular drainage.

Background: The efficacy of microsurgical treatment (MST) and endovascular treatment (EVT) in aneurysmal subarachnoid hemorrhage (aSAH) patients requiring external ventricular drainage (EVD) remains unclear. This study aims to comprehensively compare the outcomes of MST and EVT in this specific patient population. Methods: We consecutively enrolled surgical patients with aSAH requiring EVD from the Chinese Multicenter Aneurysm Database (CMAD) between January 2017 and December 2020. A 1:1 propensity score matching (PSM) was performed to balance baseline differences between the MST and EVT groups. Outcomes and complications were then compared between the matched groups. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The Kaplan-Meier survival curves were used to compare survival between the MST and EVT groups. Results: A total of 197 aSAH patients met the inclusion criteria. After PSM, 45 patients who underwent MST were matched with 45 patients who received EVT. No significant differences were observed between the MST and EVT groups in terms of 2-year mortality (MST: 32.3%; EVT: 35.5%, Conclusion: In aSAH patients requiring EVD, EVT did not demonstrate clear advantages over MST in terms of survival or functional outcomes. MST was associated with a higher incidence of intracranial infection, whereas EVT showed a relatively higher rate of pneumonia during hospitalization. Given the retrospective design and limited sample size, these findings should be interpreted with caution.