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.
Highlights
Chronic and subacute subdural hematomas are a common malady faced by the neurosurgeon
The operative management of subacute subdural hematomas and chronic subdural hematomas in the elderly is complicated by age itself, multiple medical comorbidities, and anticoagulant and antiplatelet medications; the search for less invasive, yet more effective, treatment techniques has become a goal
We present the use of a repurposed ventriculostomy catheter in the minimally invasive drainage of a mixed subacute subdural hematoma (sSDH) with the residual solid clot component subsequently liquefied with local alteplase administration in an elderly female producing effective hematoma and symptom resolution
Summary
Chronic and subacute subdural hematomas are a common malady faced by the neurosurgeon. Age-related alopecia and androgen pattern balding often make these scalp indentations and scars visible and identifiable as the result of a neurosurgical operation Another effective approach to cSDH management is the minimally invasive subdural evacuating port system (SEPS) [8,9]. How to cite this article Dorosh J, Keep M F (November 01, 2019) Minimally Invasive Subacute to Chronic Subdural Hematoma Evacuation with Angled Matchstick Drill and Repurposed Antibiotic Ventriculostomy Catheter Augmented with Alteplase: A Technical Case Report. At her four-week and 10-week follow-up appointments, the patient continued to deny any symptom return On physical exam, her strength was 5/5 bilaterally and her CT imaging at 10 weeks demonstrated minimal remaining SDH with no significant midline shift (Figure 4)
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