Tailored Tissue Plasminogen Factor Injection via Subdural Catheter for Subacute Subdural Hematoma in an Elderly Patient: A Case Report and Literature Review

This report presents an 89-year-old patient with subacute subdural hematoma (SDH) treated with local anesthesia via burr-hole trephination (BHT) and subdural drain placement, followed by liquefaction of the hematoma using the fibrinolytic agent, tissue plasminogen activator (tPA). Initially, the patient presented with acute post-trauma SDH without neurological symptoms, for which conservative treatment was administered. About a week later, the patient developed hemiplegia and progressed to a stuporous state. Radiographic evidence indicated that the subacute SDH had evolved into a chronic stage with an increased mass effect, causing new neurological deficits. Although craniotomy was considered, general anesthesia was not performed at the caregiver's request. After BHT, a subdural catheter was placed, but initial drainage was minimal. tPA was then administered to promote liquefaction and drainage. Follow-up computed tomography of the brain confirmed significant drainage of the hematoma. The patient subsequently recovered consciousness and motor function. This report discusses a less-invasive alternative for managing symptomatic subacute SDH. My approach of combining BHT with fibrinolytic therapy using tPA facilitated effective evacuation of the hematoma with minimal surgical intervention. Here, I present a case where tPA was used, detailing the methodology, imaging findings, and clinical outcomes of fibrinolytic therapy.