Middle Meningeal Artery Embolisation in Chronic Subdural Hematoma

This international multicenter study evaluates the efficacy and safety of middle meningeal artery embolization (MMAE) using PVA particles or liquid embolic agents as a perioperative treatment to prevent the recurrence of chronic subdural hematoma (cSDH). All participating patients across centers in the Czech Republic and Slovakia will receive the minimally invasive MMAE procedure within 7 days prior to or after surgical evacuation, with the primary goal of assessing hematoma recurrence rates and procedure-related complications over a 90-day follow-up period.

Inclusion Criteria: * Age 18 years or older. * Diagnosis of a symptomatic or asymptomatic chronic or subacute subdural hematoma (cSDH) confirmed by neuroimaging (CT or MRI). * Hematoma thickness of 5 mm or greater at its widest point on baseline neuroimaging. * Patient is managed either conservatively or via standard surgical evacuation (e.g., burr-hole craniostomy) where MMAE is planned as a standalone or adjunctive treatment. * Written informed consent provided by the patient or a legally authorized representative. Exclusion Criteria: * Acute subdural hematoma requiring emergency surgical decompression due to severe neurological deficit with signs of impending herniation. * Evidence of an active intracranial infection or sepsis. * Known vascular malformation, aneurysm, or dural arteriovenous fistula as the source of the hematoma. * Severe uncorrectable coagulopathy or bleeding disorder (e.g., platelet count \2.0 that cannot be safely corrected before the procedure). * Severe renal impairment (e.g., eGFR \