Evolution of surgery for chronic subdural hematoma: a narrative review

Chronic subdural hematoma (CSDH) is a common neurological condition, particularly affecting elderly populations and often requiring surgical intervention. This narrative review explores the evolution of surgical techniques for managing CSDH, highlighting the transition from invasive procedures, like craniotomy, to minimally invasive methods such as burr-hole craniostomy, twist-drill craniostomy, and middle meningeal artery embolization. Additionally, the review addresses key factors that influence treatment choice, including patient age, comorbidities, and hematoma characteristics, underscoring the importance of individualized care. Emerging technologies, such as artificial intelligence for imaging analysis and robotics for enhanced surgical precision, are also considered as potential future advancements in optimizing CSDH management. Finally, socioeconomic implications are discussed, with an emphasis on disparities in access to advanced treatments, which are often concentrated in specialized centers. This review provides a comprehensive overview of established and emerging techniques, marking the continuous progression of CSDH management toward more personalized, minimally invasive, and accessible care.