Advances in chronic subdural haematoma management: beyond the burr hole

Chronic subdural haematoma is associated with increased frailty, comorbidities including dementia, and a higher risk of mortality compared to age-matched controls, with incidence rising as populations age. Burr holes have long been considered the mainstay of surgical treatment for chronic subdural haematoma, but novel therapies are seeking to expand treatment beyond surgical burr hole drainage. Since 2020, several high-quality clinical trials have helped refine operative strategies, provided robust evidence against the routine use of steroids, and investigated minimally invasive treatment with middle meningeal artery embolisation. One treatment approach does not fit all patients, and stratification using risk factors for poor outcome might prove crucial in maximising benefit from adjuvant therapies such as middle meningeal artery embolisation. Results of further trials of middle meningeal artery embolisation and drug trials are awaited, and increased recognition of the need for multispecialist care should also help to improve outcomes for patients with chronic subdural haematoma in the future.