Minimally Invasive Subacute to Chronic Subdural Hematoma Evacuation with Angled Matchstick Drill and Repurposed Antibiotic Ventriculostomy Catheter Augmented with Alteplase: A Technical Case Report

Abstract

The operative management of subacute subdural hematomas (sSDHs) and chronic subdural hematomas (cSDHs) in the elderly is complicated by age itself, multiple medical comorbidities, and anticoagulant and antiplatelet medications; therefore, the search for less invasive, yet more effective, treatment techniques has become a goal. Here, we present the use of a repurposed ventriculostomy catheter in the minimally invasive drainage of a mixed sSDH with the residual solid clot component subsequently liquefied with local alteplase (tPA) administration in an elderly female producing effective hematoma and symptom resolution.