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

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.