To analyze the clinical efficacy and prognosis of different minimally invasive surgical treatments for patients with chronic subdural hematoma (CSDH). Methods: A retrospective analysis was conducted on clinical data from 229 CSDH patients admitted to the Affiliated Hospital of Guizhou Medical University between January 2019 and December 2024. Based on treatment modalities, they were divided into two groups: the CT-guided group (n=122, receiving CT-guided minimally invasive intracranial hematoma puncture and drainage) and the burr hole group (n=107, including 45 cases undergoing neuroendoscope-assisted burr hole drainage and 62 cases receiving simple burr hole drainage). Baseline characteristics, laboratory parameters, surgical details, preoperative/postoperative imaging findings at 48 hours, and prognostic indicators were compared between groups. Risk factors for postoperative rebleeding were also analyzed. Results: Patients in the CT-guided group exhibited higher proportions of preoperative head CT midline shift >10 mm, intraoperative irrigation rates, intraoperative urokinase utilization, and lower Glasgow Coma Scale scores (<15 points upon admission) compared to the burr hole group (all P<0.05 or P<0.01). Conversely, this group demonstrated significantly shorter surgical duration, reduced intraoperative blood loss, fewer postoperative complications (intracranial air accumulation/fluid collection), and shorter hospital stays (all P<0.05 or P<0.01). Postoperative rebleeding occurred in 46 cases (rebleeding group) versus 183 cases without rebleeding (non-rebleeding group). Univariate analysis identified prior hypertension history and alcohol consumption as risk factors for postoperative rebleeding in CSDH patients. Conclusion: The CT-guided minimally invasive technique offers advantages including increased drainage catheter placement, thorough hematoma cavity irrigation with urokinase, resulting in shorter surgery and hospitalization times, reduced intraoperative bleeding, and lower complication rates. However, no statistically significant difference in long-term outcomes was observed between the two approaches. History of hypertension and alcohol use were identified as independent risk factors for postoperative rebleeding in CSDH patients.