Introduction: Classically, hemispheric acute subdural hematoma resection is performed through a large hemicraniotomy as the presence of associated injuries is frequent. However, 30-40% of hematomas requiring surgery are isolated lesions, and therefore can be treated through minimally invasive approach.
Methods: The authors describe two cases of a neuroendoscopic excision through the parietal tangential burr hole. The first patient was admitted following falling from a height with left hemiparesis, and a right hemispheric acute subdural hematoma was diagnosed. The second patient presented with severe headache after a physical aggression and an acute subdural hematoma at the right frontal parietal region was diagnosed. Both patients were younger than 40 years old.
Results: The 3D planning using the software OsiriX (r) allowed the calculation of a tangential burr hole so that it was possible to introduce the rigid endoscope and an aspirator over the entire surface of the brain. The intraoperative view of the neuroendoscope was satisfactory and allowed total resection of the hematoma safely. Both patients had full recovery of symptoms and were discharged in two days.
Conclusions: The preoperative planning with 3D images associated with the use of neuroendoscope can be a minimally invasive alternative for treating patients with acute subdural hematomas without associated lesions, reducing the length of hospital stay and postoperative recovery.
Patient Care: Minimally Invasive Approach is the new frontier in Neurosurgery. The type of surgery used in the present report is safe and may
become the standard method for treating subdural hematomas with no associated brain swelling in a near future.
Learning Objectives: 1-Neuroendoscopy can be a minimally invasive alternative for excision of subdural hematomas
2- The Burr Hole must be placed tangentially