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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0046-1815952
Research Article

Preoperative Planning for Burr Hole Surgery in Chronic Subdural Hematoma: Visualization of the Superficial Temporal and Middle Meningeal Arteries Using Noncontrast CT

Authors

  • Takeru Hirata 

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Hajime Nishido

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Akihiro Ito

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Yasushi Ino

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Shohei Nambu

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Keisuke Yamada

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Hideki Matsumoto

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Ryosuke Yoshioka

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Hiroki Okabe

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Tomohiro Yoshihira

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan

  • Katsumi Hoya

    1   Department of Neurosurgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
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Abstract

Objectives

Recent developments in volume rendering techniques have enabled soft-tissue visualization using noncontrast computed tomography (CT). We aimed to visualize the superficial temporal artery (STA) and middle meningeal artery (MMA) using noncontrast CT to evaluate the technique's usefulness in preoperative planning for chronic subdural hematoma (CSDH).

Materials and Methods

We examined 99 hemispheres of 83 patients with CSDH who underwent burr-hole surgery between August 2019 and May 2023. Of these, 61 hemispheres were preoperatively planned. In the planned group, the STA and MMA were visualized using volume rendering on noncontrast CT scans, and burr-hole positions were planned accordingly to avoid these vessels. This study compared injury rates to the main and secondary branches of the STA and MMA between the planned and nonplanned groups. Postoperative complications including acute intracranial bleeding, subcutaneous hematoma, and CSDH recurrence were investigated.

Results

STA injury rate was significantly lower in the planned group than in the nonplanned group (21.3 vs. 42.1%, p = 0.027). Similarly, the MMA injury rate was lower in the planned group than in the nonplanned group (36.1 vs. 55.3%, p = 0.061). No cases of postoperative intracranial bleeding were observed, and hematoma recurrence rate did not significantly differ between the groups.

Conclusion

Preoperative evaluation of the STA and MMA using volume rendering from noncontrast CT is technically feasible. This approach may reduce vessel injury, particularly to branches, in burr-hole surgery for CSDH; however, further studies are needed to determine its clinical significance.

Keywords

chronic subdural hematoma - burr-hole surgery - superficial temporal artery - middle meningeal artery - volume rendering

Authors' Contributions

T.H. contributed to conceptualization, data curation, investigation, visualization, and writing the original draft. H.N. and A.I. were involved in investigation, formal analysis, and writing, reviewing, and editing the manuscript. Y.I. contributed to investigation, formal analysis, supervision, and writing, reviewing, and editing. S.N., K.Y., H.M., R.Y., H.O., and T.Y. contributed to data curation and writing, reviewing, and editing. K.H. contributed to conceptualization, formal analysis, methodology, project administration, supervision, and writing, reviewing, and editing. All authors have read and approved the final manuscript.


Ethical Approval

This study was approved by the institutional review board of our hospital (approval number: TEIRIN No. 19–229) and was performed in accordance with the principles of the Declaration of Helsinki.




Publication History

Article published online:
03 February 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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