YL-1 puncture needle-based minimally invasive drainage versus burr-hole drainage in chronic subdural hematoma: A meta-analysis of efficacy and safety

Chronic subdural hematoma (CSDH) is a common neurosurgical condition, particularly in elderly patients. While burr-hole drainage (BHD) is the standard treatment, minimally invasive puncture drainage (MIPD) using the YL-1 puncture needle has emerged as a promising alternative. This study aims to compare the efficacy and safety of MIPD with BHD for CSDH. We conducted a systematic search of English databases including PubMed, Embase, Web of Science, and the Cochrane Library for clinical studies. Five studies (464 patients) were included. The results showed that both MIPD and BHD demonstrated comparable efficacy and safety in terms of cure rate (P = 0.43), recurrence rate (P = 0.32), mortality (P = 0.94) and most complications [including pneumonia (P = 0.41), reoperation (P = 1.00), epilepsy (P = 0.93), intracranial infection (P = 0.37), and secondary brain injury (P = 0.24)]. However, MIPD showed a significant advantage in preventing pneumocrania (P < 0.00001). Furthermore, MIPD was found to significantly reduce operation time (P < 0.00001) and hospital stays (P < 0.00001) compared to BHD. Subgroup analysis suggested that the type of study, the use of urokinase, and intraoperative irrigation had no significant effect on the recurrence rate after MIPD surgery. However, MIPD with the double-needle drainage could significantly reduce the postoperative recurrence rate (P = 0.01). Both MIPD and BHD are effective treatments for CSDH, demonstrating comparable cure and recurrence rates. For elderly patients with multiple comorbidities and high surgical risks, MIPD offers a safer and more efficient alternative.