An unusual case of waterskiing-related acute subdural hematoma in an adolescent treated with endoscopic assisted hematoma evacuation

We report the case of waterskiing-related acute subdural hematoma (ASDH) in an adolescent who was successfully treated with endoscopic assisted hematoma evacuation. An 18-year-old male sustained head injury during waterskiing and was referred to our hospital. He had a history of traumatic subarachnoid hemorrhage two years ago. Neurological examination showed mild left hemiparesis and altered consciousness. Computed tomography (CT) indicated ASDH. Cranioplastic craniotomy following rapid mannitol infusion was performed. After dural incision, a rigid endoscope was introduced through the craniotomy, and a malleable suction cannula was used to evacuate the hematoma. Postoperative CT showed near-complete evacuation. The postoperative course was uneventful, and the patient was discharged to home. The exact mechanisms of waterskiing-related ASDH are unclear; however, rotational acceleration of the brain might cause separation of the brain and the dura mater, with consequent rupture of the bridging veins. Moreover, a history of traumatic subarachnoid hemorrhage in the current case might have contributed to the development of ASDH after a relatively mild head trauma. Careful evaluation for the indication of endoscopic intervention and intracranial pressure monitoring following surgery are imperative for endoscopic evacuation in young patients with ASDH. •Waterskiing-related ASDH in trick maneuvers is extremely rare.•Rotational acceleration of the brain might cause consequent rupture of the bridging veins and ASDH.•Waterskiing-related ASDH in an adolescent was successfully treated with endoscopic assisted hematoma evacuation.