Minimally invasive evacuation of chronic subdural hematoma: Repurposing a spinal rigid endoscope.

Introduction: Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly in the elderly. Standard treatment with burr-hole evacuation may be insufficient in septated or recurrent cases. Endoscopic techniques improve visualization and completeness of evacuation, but dedicated cranial neuroendoscopes are not universally available. Research question: Can a spinal rigid endoscope be safely and effectively repurposed for the endoscopic evacuation of recurrent, septated cSDH? Materials and methods: We present a single-case proof-of-concept study using a rigid spinal endoscope (Elliquence, LLC) originally designed for spine surgery. The system includes a 30° angled optic, integrated working channel, and compatibility with suction, irrigation, and bipolar coagulation tools. A small frontoparietal craniotomy was performed, and the spinal endoscope was introduced into the subdural space for inspection, evacuation, and hemostasis. Results: The endoscope enabled visualization of organized clots, fibrous septa, and fragile neovessels, all of which were managed under direct vision. A subdural drain was accurately placed. Postoperative CT confirmed significant hematoma reduction by 83 % and midline re-expansion. The patient experienced full neurological recovery without complications. Discussion and conclusion: Repurposing a spinal endoscope provides a practical alternative for endoscopic cSDH evacuation, particularly in settings lacking cranial neuroendoscopic systems. The technique enhances visualization, enables membrane and vessel management, and supports precise drain placement. Further studies are warranted to assess efficacy, safety, and reproducibility in larger cohorts.