| Summary: | Background: Acute subdural hematoma (ASDH) is generally managed by large craniotomy with extended operating time and high relative blood loss. Recently, minimally invasive endoscopic hematoma evacuation of ASDH has been successfully demonstrated; however, non-elderly patients, moderate or massive cerebral contusion, and enlarging hematoma are generally not accepted as indications for endoscopic surgery. Clinical presentation: We report our experience with two ASDH patients with impending herniation successfully evacuated via an endoscopic surgery following emergent burr hole craniostomy. Case 1: A 70-year-old man was admitted to our hospital because of severe head trauma. Neurological examination demonstrated a fixed, dilated right pupil and a CT scan showed ASDH. The entire procedure was completed in approximately 2.5 h. He was transferred to a rehabilitation hospital. Case 2: A 51-year-old comatose woman was transferred to our hospital after a motor vehicle accident. Radiological examination revealed ASDH and severe multiple trauma. Acute traumatic coagulopathy was confirmed by laboratory tests. The entire procedure was completed in approximately 1.5 h. Almost complete evacuation of the hematoma was achieved. Conclusion: If intracranial pressure becomes sufficiently low after emergent burr hole craniostomy, endoscopic hematoma evacuation of ASDH may be a safe and effective method even in critically injured patients. Keywords: Acute subdural hematoma, Burr hole surgery, Endoscopic evacuation, Minimally invasive surgery, Intracranial pressure, Acute traumatic coagulopathy
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