334 Natural Evolution of Chronic Subdural Hematoma: Challenging the Trend Towards MMA Embolization

INTRODUCTION: This study aims to assess the natural progression of chronic subdural hematoma (CSDH) and delineates a treatment algorithm evaluating the effectiveness of current treatment strategies vs. emerging treatments as MMAe. METHODS: This was a retrospective single-surgeon study for 100 consecutive patients with confirmed CSDH from 2017-2024. This study delineates a treatment algorithm tailored to the clinical presentation of the patients. Asymptomatic individuals and those with minimal symptoms were managed conservatively with corticosteroids. Symptomatic patients underwent surgical intervention via burr-hole craniostomy accompanied by subdural drain placement. For cases presenting with recurrence following initial surgical management, MMAe was a secondary intervention strategy. Charge analysis was additionally performed to quantify the cost burden of both procedures on patients. RESULTS: 67 patients were intially started on medication management with 45 (45%) experiencing resolution. 18 patients (18%) required no treatment before resolution, 37 (37%) required surgical management with resolution, with 22 (22%) patients progressing from medical mangement to surgery due to symptom progression. No complications or recurrences were noted in the cohort, with no patients progressing to MMAe due to no confirmed recurrence. Charge analysis revealed an average of $61,000 for MMAe with an average of $11,000 for burrhole evacuation. CONCLUSIONS: This study highlights the effective management of CSDH via either medication management, no intervention, or evacuation via burr-hole. Despite previously reported data highligting high recurrence rates of CSDH following burrhole evacuation, we reported no recurrences in our cohort, we additionally highlight the cost burden to patients between the two procedures. We highlight the effectiveness of our algorithm in management of CSDH and encourage further investigation into the management of CSDH and effectivness of burrhole evacuation vs. MMAe.