In this multicenter retrospective cohort of 265 CSDH patients, MMAE and NE-MMAD were associated with lower recurrence than burr hole drainage, NE-MMAD with the greatest neurological improvement, and treatment should be individualized by haematoma characteristics, patient status, and available resources.
Six-month recurrence was significantly lower after MMAE and NE-MMAD than after burr hole drainage.
The neurological improvement rate was highest in the NE-MMAD group.
Reoperation rates were lower for MMAE and NE-MMAD than for BHD.
MMAE had the shortest operation time and hospital stay, while NE-MMAD had the longest operation time.
MMAE and NE-MMAD required fewer imaging follow-ups than BHD.
Overall complication rates did not differ significantly among the three groups, but one MMAE patient suffered permanent blindness.
The authors propose stratified treatment selection according to haematoma characteristics and patient status.
This study compared three ways of treating chronic subdural haematoma, a slow collection of blood between the brain and skull that often affects older adults. The approaches were drilling a small hole to drain it (burr hole drainage), blocking the artery that feeds the haematoma (middle meningeal artery embolization), and using a small camera to clear the blood while also cutting off that artery (neuroendoscopic evacuation with MMA disconnection). The researchers looked back at records of 265 patients across multiple centers. About 1 in 5 patients (19.7%) who had burr hole drainage had the haematoma return within six months, compared with about 4% for each of the other two approaches. Neuroendoscopic surgery was linked to the most neurological improvement (88%). Embolization had the shortest procedure and hospital stay, but about 11% of those patients still needed a rescue drain because the pressure on the brain was slow to resolve, and one patient went permanently blind because of an unintended blockage of a connected vessel. Neuroendoscopic surgery took the longest (about 70 minutes). Overall complication rates were not significantly different. This research suggests that no single treatment is best for everyone. Simple drainage may suit first-time, uncomplicated haematomas, embolization may suit older patients or those with clotting problems, and the endoscopic approach may suit complex, recurrent, or large haematomas. Because this was a retrospective study without randomization, the groups may have differed in ways that affected results, so the findings show associations rather than proof of which treatment is better.
Song X, Zhang Y, Luo B, Tang X. (2026). Comparative outcomes of middle meningeal artery embolization, burr hole drainage, and neuroendoscopic-assisted evacuation with MMA disconnection for chronic subdural haematoma: a multicenter retrospective cohort study.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1975364