Abstract: Objective    Chronic subdural hematoma (CSDH) is a prevalent and severe clinical condition that poses significant treatment challenges. The current surgical procedures are inadequate in addressing the removal and prevention of the hematoma, often resulting in high recurrence rates. This study developed a novel surgical procedure and validated its therapeutic effect.   Methods    Considering the anatomical features of CSDH and the middle dura mater artery, the author proposed a procedure known as Endoscopic Assisted Hematoma Evacuation and Mediated Meningeal Artery Angiogomy (EHEMMA). This retrospective study detailed the EHEMMA procedure and evaluated the conditions of patients and clinical outcomes, comparing them in the EHEMMA cohort with those of the cohort control undergoing Endoscopic Assisted Hematoma Evacuation (EHE).   Results  Thirty-two patients with CSDH were included in the EHEMMA group and 41 patients in the EHE group. Compared with the EHE group, the recurrence rate of hematoma was markedly reduced in the EHEMMA group (P=0.048), at 180 days following the surgeries. No patients in the EHEMMA group required additional surgery, while 6 patients in the EHE group received secondary surgeries. There were no significant differences between the two cohorts in terms of favorable outcomes, mortality, postoperative acute intracranial hemorrhage, and surgical site infection.    Conclusions The EHEMMA procedure is deemed to be as safe as EHE and can significantly lower the risk of postoperative hematoma recurrence in CSDH patients. It also reduces the need for secondary surgeries, thus achieving comparable outcomes to EHE surgery in a cost-effective way.

Key words: Chronic subdural hematoma; ,  , Neuroendoscopy; ,  Hematoma evacuation; ,  Medial meningeal artery