Endoscopic Hematoma Evacuation for Spontaneous Acute Subdural Hematoma: The Role of Preoperative Imaging

Spontaneous acute subdural hematoma (SDH) is a rare but potentially life-threatening condition. We present the case of a 73-year-old man with spontaneous acute SDH in which a computed tomography angiography (CTA) demonstrated contrast extravasation from a cortical artery. The patient was successfully treated with endoscopic hematoma evacuation via a small craniotomy, minimizing surgical invasiveness. This case highlights the value of CTA as an essential initial imaging modality for identifying the bleeding source and guiding treatment, particularly for endoscopic hematoma removal with a small craniotomy.