Mini-Craniotomy With Endoscopic Approach for Acute Subdural Hematoma Evacuation in a Patient With Complex Scalp Flap Defect: A Case Report.

Background and importance: Acute subdural hematoma (aSDH) is one of the most common pathologies resulting from head trauma. Surgical management often involves a large craniotomy for hematoma evacuation. Prior complex cranial reconstructive surgery can complicate incision planning or limit craniotomy size.

Clinical presentation: In this report, we describe a 61-year-old woman with a history of squamous cell carcinoma of the scalp, which previously required complex flap reconstruction and left a residual skull defect, who presented with an aSDH after a fall. Prior surgery and poorly vascularized skin significantly limited the available area for craniotomy. We used a mini-craniotomy with endoscopic adjunct to achieve appropriate visualization and complete evacuation of the hematoma.

Conclusion: In cases of aSDH in which a mini-craniotomy is desirable and the potential location of the incision is limited, an endoscopic approach should be considered.