The usefulness of computed tomography angiography for endoscopic hematoma evacuation for acute spontaneous subdural hematoma of arterial origin

Abstract

Acute spontaneous subdural hematoma (SDH) of arterial origin is rare in the field of neurosurgery. We report a 57-year-old male patient developed sudden onset headache and right hemiparesis. He had no history of head trauma.A computed tomography demonstrated an acute left-sided SDH. A computed tomography angiogram (CTA) demonstrated active contrast extravasation from a small cortical middle cerebral artery (MCA) branch into the left-sided SDH. Endoscopic surgery was performed to evacuate the hematoma,we verified the arterial origin of the bleeding and coagulated the bleeding point. Postoperatively the patient’s symptoms clearly improved. He was discharged 7 days after surgery. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered, The initial radiologic investigation in a patient with a spontaneous acute SDH should be a CT and CTA. Endoscopic hematoma evacuation of acute spontaneous SDH may be a safe and effective method in some cases.