This video demonstrates the surgical evacuation of an acute subdural hematoma in an elderly patient with impaired consciousness. Following careful positioning to optimize venous return and minimize intracranial pressure, a burr hole and craniotomy were performed. The hematoma was evacuated under direct visualization, with care taken to preserve dural integrity. Restoration of brain pulsation confirmed effective decompression. The procedure concludes with watertight dural closure and replacement of the bone flap. This case highlights standard operative technique for acute subdural hematoma evacuation in the context of prior chronic hematoma.