Endoscopic evacuation for interhemispheric acute subdural hematoma: A case report

Acute subdural hematoma (ASDH) of the interhemispheric fissure is frequently experienced but is rarely indicated for surgery. We report a case of ASDH of the interhemispheric fissure that was treated with an endoscopic procedure.

A 73-year-old woman had undergone craniotomy for subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm and ventriculoperitoneal shunt for hydrocephalus after SAH. On X day, she fell and bruised the back of her head, resulting in weakness of the left upper and lower limbs, and she was brought to the emergency department on X + 1 day. When she came to our hospital, she was found to have left hemiplegia with lower limb dominance. Head computed tomography (CT) scan showed a 2.5 cm thick ASDH on the right side of the posterior half of the interhemispheric fissures. It was thought that paralysis was caused by this lesion, and we decided to perform surgery based on the belief that symptoms would improve if the mass effect could be alleviated. As for the surgical technique, craniotomy and ventriculoperitoneal shunt had been performed in the past; endoscopic evacuation of hematoma was performed with a small craniotomy. The day after surgery, a head CT scan confirmed that the hematoma had been successfully removed to a deep level and the pre-operative left hemiplegia had improved. Two months after surgery, the patient was discharged from the hospital with a modified Rankin Scale 2.

We have experienced a case of interhemispheric fissure ASDH that was treated by endoscopic hematoma evacuation. Endoscopic procedure is non-invasive, and good results were achieved.