Chronic subdural hematoma (CSDH) is a common neurological affliction which affects mostly frail and elderly patients.

Surgical evacuation by using burr hole craniostomy (BHC) is the most frequently used treatment but carries a recurrence rate varying between 10-30% in the literature. Especially in this frail population re-operation is undesirable.

Embolization of the middle meningeal artery is an adjuvant treatment which has been reported in multiple case reports and larger case series, showing a beneficial effect on recurrence rate, reducing it to <5%, without complications.


To evaluate whether additional embolization of the middle meningeal artery after surgery for CSDH reduces the recurrent surgery rate.

- Quality of life (SF-36 and the EQ-5D-5L)
- Performance in activities of daily living (AMC Linear Disability Score)
- Functional outcome (mRS)
- Cognitive functioning (MOCA)
- Mortality
- Complications
- Recurrence rate
- Size and volume of the hematoma
- Neurological impairment (mNIHSS, Markwalder score)
- Use of care and health-related costs (iMCQ and iPCQ)


Multicenter, randomized controlled open-label superiority trial.

Study population: Patients diagnosed with a CSDH who require surgery.


The intervention group will receive embolization in addition to standard surgical treatment.

The control group will receive surgery only.