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Introduction Subacute/chronic subdural hematomas are common and frequently recur after surgical evacuation. Multiple randomized trials have demonstrated efficacy of middle meningeal artery embolization to prevent recurrence of subdurals after surgical drainage.Aim of Study The EMBOLISE study allowed embolization of the middle meningeal artery either before or after surgical drainage, and this study analyzes the that timing may have on the effectiveness of embolization.Method The EMBOLISE surgical trial is a multicenter, prospective, randomized, interventional, adaptive trial of middle meningeal artery embolization combined with surgical evacuation of the subdural clot compared to surgery only. We analyzed the relationship of the primary endpoint, ie.the rate of hematoma recurrence/progression requiring repeat surgical drainage, to timing of the embolization procedure.Results A total of 185 patients underwent embolization procedures in the intervention arm (surgery + embolization), of which 42.2% underwent surgery prior to the Onyx embolization procedure. In the intervention arm, only 6 embolized patients failed the primary endpoint, all of whom were embolized prior to surgery. There was no significant difference in technical success, as assessed by the imaging Core Lab. Both pre- and post-surgical embolization was found to have 100% technical success, as assessed by radiographic presence of onyx within the target vessel.Conclusion In patients with subacute/chronic subdural hematoma requiring surgical drainage, failure of adjunctive middle meningeal artery embolization to prevent hematoma recurrence/progression requiring repeat surgical drainage only occurred in patient who underwent embolization prior to surgical drainage. Further study on the impact of timing of adjunctive middle meningeal artery embolization is required.Conflict of Interest Yes Consultant for Medtronic