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Research Snapshot Theater: Procedures, Adult II

Airway Compromise Following Subdural Evacuating Port System Placement: A Rare Complication

Sunday, March 22, 2026
11:00 AM - 12:00 PM Central Time
Location: Connections Central - RST 12

  • Imad Isaac, MD (he/him/his)

    MedStar Washington Hospital Center, District of Columbia

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • YZ

    Yani Zhang, MD, M.Med

    Disclosure information not submitted.

  • LY

    Linjie Yan, MD

    Fellow Physician
    Buffalo General Medical Center

    Disclosure information not submitted.

  • LM

    Lokesh Manjani, MD

    Attending Physician
    MedStar Washington Hospital Center

    Disclosure information not submitted.

  • ZP

    Zonghao Pan, MD

    Attending Physician
    Conemaugh Health System

    Disclosure information not submitted.

Introduction: The subdural evacuating port system (SEPS) is a minimally invasive method for treating acute and subacute subdural hematomas (SDH), often reducing the need for open craniotomy. While SEPS has demonstrated safety and efficacy, rare complications can occur. We presented a unique case of cerebrospinal fluid (CSF) tracking and central nervous system (CNS) infection leading to life-threatening airway obstruction requiring critical airway management following SEPS placement.


Description: An elderly male was admitted after a fall with bilateral acute SDHs. He underwent bilateral SEPS placement on admission. The initial postoperative course was uneventful, and SEPS drains were removed after 48 hours. On day 6, the patient developed fever, lethargy, and tachycardia. A fluctuant scalp mass with CSF leakage was noted at the previous SEPS site, raising suspicion for CNS infection.
En route to a CT scan, the patient acutely developed inspiratory stridor and failed bag-mask ventilation. Emergent airway management revealed profound supraglottic watery edema obstructing vocal cord visualization. After over ten failed intubation attempts, a flexible bronchoscope was modified and used as a bougie to successfully place a 5.0 endotracheal tube past subglottic resistance. Head CT was unchanged; neck CT showed no mass or abscess. EEG was non-diagnostic.
CT and physical findings suggested CSF leakage tracking into subgaleal tissues (seroma), possibly from an occult arachnoid breach, which could also lead to supraglottic inflammation and edema and increased risk of CNS infection but won't show on CT. CSF analysis confirmed bacterial meningitis with culture positive for Providencia stuartii. The hospital course was later complicated by VZV reactivation with possible CNS involvement. Despite antiviral and antibiotic therapy, the patient’s condition deteriorated. After 25 days of hospitalization, family decided to initiate comfort care, and patient was palliatively extubated.


Discussion: SEPS is widely used for SDH evacuation, with low complication rates. However, this case revealed a rare but serious delayed complication: CSF tracking and meningitis leading to upper airway obstruction. Early recognition of subtle signs such as scalp swelling and prompt airway and infection management may improve outcomes.