Chronic subdural hematoma (cSDH) is one of the most prevalent neurosurgical diseases, especially in the elderly. Yet, its incidence is predicted to increase further, paralleling the growth of the geriatric population. While surgical evacuation is technically straightforward, it is associated with significant morbidity and mortality. In fact, 30% of patients are expected to have hematoma recurrence and to need repeat surgical evacuation, and 20% of patients are expected to lose independence and require long-term care. A pathophysiology more complex than originally presumed explains the disappointing results observed for decades. At its core, the formation of microcapillaries and anastomotic channels with the middle meningeal artery (MMA) perpetuates a constant cycle resulting in persistence of hematoma. The rationale behind MMA embolization is simple: to stop cSDH at its source. Over the last few years, this “newer” option has been heavily studied. It has shown tremendous potential in decreasing hematoma recurrence and improving neurological outcomes. Whether combined with surgical evacuation or performed as the only treatment, the scientific evidence to its benefits is unequivocal. Here, we aimed to review cSDH in the elderly and discuss its more recent treatment options with an emphasis on MMA embolization.

慢性硬膜下血肿（cSDH）是最常见的神经外科疾病之一，特别是在老年人中。然而，随着老年人口的增长，预计其发病率将进一步增加。虽然手术清除在技术上很简单，但它与显着的发病率和死亡率相关。事实上，30% 的患者预计会出现血肿复发并需要重复手术清除，20% 的患者预计会失去独立性并需要长期护理。比最初假设的更复杂的病理生理学解释了几十年来观察到的令人失望的结果。从本质上讲，微毛细血管和与脑膜中动脉（MMA）吻合的通道的形成维持了恒定的循环，导致血肿持续存在。 MMA 栓塞背后的原理很简单：从源头上阻止 cSDH。在过去的几年里，人们对这种“较新”的选择进行了深入研究。它在减少血肿复发和改善神经系统预后方面显示出巨大的潜力。无论是与手术清除相结合还是作为唯一的治疗方法，其益处的科学证据都是明确的。在这里，我们的目的是回顾老年人的 cSDH 并讨论其最新的治疗方案，重点是 MMA 栓塞。