Endovascular Embolization for Chronic Subdural Hematomas: A Literature Review of the Current Evidence

Chronic subdural hematoma (cSDH) primarily affects elderly patients along with those who have multiple health problems, while it develops when blood collects between the dura mater and the brain. The condition results in substantial disability while also causing surgical treatment failures in certain cases. The occurrence of cSDH becomes more frequent as people age beyond 65 years old, which establishes this condition as a major health issue. The standard surgical evacuation method for treating this condition shows limited success because patients experience frequent recurrences, which motivates researchers to study endovascular embolization as an alternative treatment option. The promising endovascular embolization technique uses middle meningeal artery (MMA) embolization to target the blood supply of the neo-membrane surrounding the hematoma, thus preventing rebleeding and reducing recurrence. The available data shows that embolization of the MMA leads to better recurrence prevention than conventional surgical procedures among patients who face restrictions for surgery because of multiple health issues. The review analyzes current research about MMA embolization safety together with its effectiveness and appropriate applications for cSDH treatment. The existing evidence about endovascular embolization as adjunctive therapy to surgical procedures such as burr hole drainage or craniotomy provides a significant impact over standalone treatment for complex and recurrent cSDH cases, reducing recurrence, rescue rates, and complications. However, endovascular embolization also shows better clinical outcomes in reducing these outcomes, but for less complex cSDH cases. There is unclear or inconclusive evidence for overall cSDH patients because current research lacks large multicenter randomized controlled studies together with stringent quality standards and contains various patient groups and minimal study durations. The procedure's effectiveness remains unclear because researchers have not determined the best patient selection criteria, the most suitable embolic agent, or the most economical approach.