Bilateral Middle Meningeal Artery Embolization and Burr Hole Drainage for Recurrent Bilateral Chronic Subdural Hematoma.

Bilateral chronic subdural hematoma (bCSDH) represents a common neurosurgical entity frequently associated with elevated retreatment rates. However, the underlying mechanisms driving its high recurrence remain incompletely understood. Emerging evidence implicates the middle meningeal artery (MMA) in the pathogenesis and progression of chronic subdural hematomas. The authors present a case of bCSDH managed with combined bilateral MMA embolization and burr hole evacuation in a 79-year-old male. The patient had sustained a closed head injury 3.5 months prior, initially managed with bilateral burr hole drainage. Recurrent bCSDH was diagnosed 1 month before presentation. After bilateral MMA embolization integrated with burr hole drainage, serial head CT demonstrated progressive resolution of the bCSDH. The patient achieved uneventful recovery with no recurrence observed during follow-up. This case highlights the efficacy of combined bilateral MMA embolization and surgical evacuation for bCSDH, suggesting its potential to mitigate recurrence risk.