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Related Experiment Video

Updated: Jan 14, 2026

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Chronic Subdural Hematoma Treatment with Embolization Versus Surgery Study (CHESS): Trial Rationale and Protocol.

Manisha Koneru1, Ajith J Thomas1, Farhan Siddiq2

  • 1Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA.

International Journal of Cerebrovascular Disease and Stroke
|October 17, 2025
PubMed
Summary

The CHESS trial compares standalone Middle Meningeal Artery Embolization (MMAE) to surgery for Chronic Subdural Hematoma (CSDH). This study aims to establish MMAE as a safe and effective standalone treatment for CSDH.

Keywords:
Chronic subdural hematomaClinical trialEmbolizationEndovascular proceduresIntention to treat analysisTrial protocolcraniotomy

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Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Clinical Trials

Background:

  • Chronic Subdural Hematoma (CSDH) is typically managed with medication or surgery.
  • Middle Meningeal Artery Embolization (MMAE) shows promise for reducing CSDH recurrence and need for rescue surgery.
  • Lack of randomized controlled trial data for standalone MMAE in CSDH treatment.

Purpose of the Study:

  • To compare standalone MMAE against conventional surgery for treating moderately symptomatic CSDH.
  • To evaluate the safety and efficacy of MMAE as a standalone CSDH treatment.
  • To provide data for advancing endovascular approaches in CSDH management.

Main Methods:

  • Prospective, multi-center, open-label randomized controlled trial (CHESS study).
  • Randomization of CSDH patients 1:1 to conventional surgery or standalone MMAE.
  • 180-day follow-up period to assess outcomes.

Main Results:

  • Primary endpoint: composite of rescue surgery and/or mortality within 180 days.
  • Safety outcomes assessed: ischemic stroke, adverse events, neurological status, seizures, cranial neuropathy.
  • Exploratory endpoints: hematoma volume reduction, functional outcomes, quality of life, cognition, headache severity.

Conclusions:

  • CHESS is the first RCT to assess standalone MMAE versus conventional surgery for moderate CSDH.
  • Results will inform the role of endovascular techniques in CSDH treatment.
  • This trial addresses a critical gap in evidence for MMAE in CSDH management.