Atypical acute subdural hematoma caused by skull base fracture lacerating the middle meningeal artery: illustrative case

BACKGROUND Acute subdural hematoma (ASDH) is a worrisome condition. The majority of traumatic ASDHs are secondary to the rupture of bridging veins. In cases of life-threatening rise of intracranial pressure, surgery can be indicated to alleviate intracranial pressure through a craniotomy with or without bone flap replacement. OBSERVATIONS Here, the authors report the case of a 76-year-old male with a traumatic ASDH secondary to a skull base fracture causing laceration of the middle meningeal artery (MMA) at the foramen spinosum (FS). To the best of the authors’ knowledge, ASDH secondary to laceration of the MMA has not been reported. They discuss relevant radiological and surgical anatomy as well as surgical implications. LESSONS Balloon-shaped anteroinferior hematoma is a hint of proximal laceration of the MMA. The FS must be carefully checked on imaging when dealing with ASDH. In such cases, the surgical approach should allow easy access to the middle fossa.