Objective <p>Burr-hole surgery is a standard treatment for chronic subdural hematoma (CSDH); however, its persistently high recurrence rate remains a major clinical challenge. Recurrence is thought to arise from the inability of conventional burr-hole surgery to interrupt the arterial supply from the middle meningeal artery (MMA). In this study, we evaluated the clinical efficacy of a modified surgical approach, burr-hole drainage and irrigation with MMA coagulation and severance (B-MACS), in which the burr hole is placed directly over the MMA identified on preoperative three-dimensional computed tomography (3D-CT).</p> Methods <p>Patients with CSDH who underwent burr-hole surgery during April 2024–November 2025 were retrospectively analyzed. Clinical outcomes, including recurrence within 3 months after surgery and procedure-related complications, were compared between cases in which B-MACS was unsuccessful (Group A) and those in which B-MACS was successful (Group B).</p> Results <p>In total, 107 hematomas were evaluated. The mean age of the patients was 81 years, and 68% were men. B-MACS was successfully achieved in 31 hematomas (Group B). Recurrence was observed in 12 hematomas (15.8%) in Group A and in 1 hematoma (3.2%) in Group B, suggesting a lower recurrence rate with successful B-MACS. No surgical complications occurred in either group.</p> Conclusions <p>B-MACS may serve as a safe and effective surgical adjunct for the management of CSDH. This method provides a pathophysiologically rational strategy for reducing recurrence without increasing operative risk. Because burr-hole placement can be planned using noncontrast 3D-CT alone, B-MACS can be adopted without additional imaging costs or endovascular resources.</p>