ArticleNeurosurgical review2026
Three-dimensional computed tomography-guided burr-hole surgery with middle meningeal artery coagulation and severance (B-MACS) for chronic subdural hematoma: a retrospective clinical study.
Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveBurr-hole surgery is a standard treatment for chronic subdural hematoma (CSDH); however, its persistently high recurrence rate remains a major clinical challenge. Recurrence is thought to arise from the inability of conventional burr-hole surgery to interrupt the arterial supply from the middle meningeal artery (MMA). In this study, we evaluated the clinical efficacy of a modified surgical approach, burr-hole drainage and irrigation with MMA coagulation and severance (B-MACS), in which the burr hole is placed directly over the MMA identified on preoperative three-dimensional computed tomography (3D-CT).
methodsPatients with CSDH who underwent burr-hole surgery during April 2024–November 2025 were retrospectively analyzed. Clinical outcomes, including recurrence within 3 months after surgery and procedure-related complications, were compared between cases in which B-MACS was unsuccessful (Group A) and those in which B-MACS was successful (Group B).
resultsIn total, 107 hematomas were evaluated. The mean age of the patients was 81 years, and 68% were men. B-MACS was successfully achieved in 31 hematomas (Group B). Recurrence was observed in 12 hematomas (15.8%) in Group A and in 1 hematoma (3.2%) in Group B, suggesting a lower recurrence rate with successful B-MACS. No surgical complications occurred in either group.
conclusionsB-MACS may serve as a safe and effective surgical adjunct for the management of CSDH. This method provides a pathophysiologically rational strategy for reducing recurrence without increasing operative risk. Because burr-hole placement can be planned using noncontrast 3D-CT alone, B-MACS can be adopted without additional imaging costs or endovascular resources.
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