Management of Chronic Subdural Hematoma; Middle Meningeal Artery Embolization versus Surgical Evacuation: A Comparative Study

Background: Chronic subdural hematoma (CSDH) is a prevalent neurosurgical pathology greatly impacting elderly cases and is correlated to significant morbidity and death Aim: This study aimed to compare the clinical and radiological results between surgical evacuation and middle meningeal artery embolization in the management of chronic subdural hematoma. Material and Methods: This was a prospective, non-randomized case series clinical trial study that was conducted on symptomatic chronic subdural patients who were admitted to Cairo University Hospitals starting from October 2022 to October 2023. Results: All patients experienced postoperative headache relief, with immediate improvement in Group A and delayed improvement from the second month in Group B. Motor power also improved immediately in Group A, while Group B showed improvement starting from the second month. According to the Markwalder grading system, Group A showed non-significant improvement (p = 0.082), with most patients initially at grade 1, while all Group B patients were grade 1 on admission. The average postoperative hospital stay was significantly shorter in Group B (2.5 ± 1.0 days) in comparison with Group A (5.20 ± 4.31 days), reducing infection risk; this variance was highly statistically significant (p < 0.001). Conclusion: Surgical evacuation offers immediate symptom relief and reduced hematoma thickness, while long-term clinical and radiological outcomes are comparable to surgery and MMA embolization. MMA embolization is less invasive, lower-risk, and quicker, but requires close monitoring and is effective in carefully selected non-acute cases.