Unusual Case of Acute Subdural Hematoma after Endoscopic Third Ventriculostomy: A Case Report and Comprehensive Literature Review

Background: Endoscopic third ventriculostomy (ETV) is a valuable treatment for obstructive hydrocephalus, but it is not without complications. We present a rare case of acute subdural hematoma following ETV and provide a literature review on the subject. Case Description: A 23-year-old patient underwent ETV in 2016 for hydrocephalus, resulting in symptom improvement. Four years later, the patient experienced a recurrence of symptoms and underwent a second ETV. Meningitis developed, causing a decline in neurological status. Imaging revealed a calcified mesencephalic lesion, tri-ventricular hydrocephalus, and an acute right parieto-temporo-occipital subdural hematoma. Surgical evacuation and external ventricular drainage were performed, followed by CSF sterilization and a self-adjusting valve placement. Conclusion: Excessive CSF loss during ETV may contribute to subdural hematoma. ETV remains the preferred treatment for non-communicating hydrocephalus, and enhanced training and experience can reduce complication rates.