Prevalence, etiology, risk factors, management options, and outcomes in chronic subdural hematoma (cSDH): A comprehensive literature review of recent advances

• Chronic Subdural Hematoma (cSDH) is a common condition in neurosurgery procedures with a high rate of recurrence. • Most cSDHs are caused by trauma, coagulation disorders and intracranial hypotension. • The cSDH has many management approaches with considering chance of success, and recurrence rate in the setting of cSDH. • The main primary cSDH risk factors have different types and mechanism. • The cSDH risk factors for recurrence are mostly Patient Age, Antithrombotic Medications and Bilateral Hematomas. Chronic subdural hematoma (cSDH) is a significant neurosurgical disorder with a rising incidence (1.7–20.6 per 100,000 people annually) and a recurrence rate of 10–20 %. The aging global population has led to an increased disease burden, with notable impacts on morbidity and mortality among elderly patients. This narrative review aims to provide a comprehensive synthesis of recent advances in the prevalence, etiology, risk factors, management strategies, and outcomes of cSDH, highlighting their clinical implications. A narrative review methodology was employed. Literature was searched systematically in PubMed, Scopus, and Web of Science covering January 2000 to April 2025, using keywords related to “chronic subdural hematoma,” “risk factors,” “management,” and “outcomes.” Inclusion criteria encompassed relevant cohort studies, meta-analyses, and clinical guidelines, with a focus on studies published in English. Risk factors, etiologies, therapeutic approaches, and prognostic variables were extracted and synthesized. cSDH predominantly affects elderly men, with major risk factors including advanced age, male sex, head trauma, use of antiplatelet or anticoagulant agents, and chronic alcohol use. Etiological mechanisms involve bridging vein injury, chronic inflammation, angiogenesis, and impaired hemostasis. Management options consist of conservative therapy, pharmacological agents (such as dexamethasone and atorvastatin), minimally invasive procedures (e.g., middle meningeal artery embolization), and surgical interventions. Decision-making should be individualized based on patient comorbidities and risks. Prognosis is influenced by age, comorbid conditions, hematoma characteristics, and selected therapy. Surgical drainage remains the mainstay of treatment but carries recurrence risk, especially in older adults with multiple comorbidities. Understanding current evidence regarding cSDH pathophysiology, risk stratification, and treatment modalities is essential for optimizing outcomes. Continued research is warranted to refine preventive, diagnostic, and management approaches, particularly for high-risk populations.