Pneumocephalus after surgical evacuation of chronic subdural hematoma: Is it a serious complication?

Abstract

Background:Pneumocephalus is commonly encountered after surgical evacuation of chronic subdural hematoma (CSDH). This study was done to study the incidence, clinical presentation, and management of patients who developed pneumocephalus after surgical evacuation of CSDH.Materials and Methods:This prospective study was carried out on consecutive 50 patients who had received surgical treatment for CSDH. All the patients included were followed-up postoperatively with regular clinical and computed tomography (CT) examinations immediately postoperatively, before discharge, and 2 months after surgery. Pneumocephalus was classified into simple and tension, based upon the clinical and radiological criteria. The neurologic grading system of Markwalder et al was used to evaluate the surgical results.Results:The immediate postoperative CT scan showed pneumocephalus in 22 patients (44%). Tension pneumocephalus was found in two patients who did not require any further surgery. There was statistically significant increase in the incidence of pneumocephalus (immediate and postoperative) in the patients aged over 60 years as well as those presenting with a midline shift more than 5 mm in their CT scan. With regard to the 22 cases of pneumocephalus, good postoperative results were found in 16 patients (73%), while bad results were found in 6 patients (27%). No statistically significant difference in the outcome between patients who had pneumocephalus after surgery and those who had not.Conclusion:Pneumocephalus after surgical evacuation of CSDH is a common finding in the immediate CT scan as well as at time of discharge. Tension pneumocephalus may not require surgical intervention and simple aspiration of air using a syringe may be sufficient.

Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation

“…These findings confirm that some post-surgery subdural hematoma patients have intracranial air post-operatively [3, 13, 15]. …”

“…Nor, can one presume that just time passing before flying will resolve post-operative intracranial air predictably, since this is recognized to require weeks to resolve spontaneously [13]. …”

Tension Pneumocephalus with Mount Fuji Sign

“…Figure 1: Bilateral tension pneumocephalus with significant mass effect and Mount Fuji sign.Tension pneumocephalus is an uncommon and life-threatening neurological condition. The incidence of tension pneumocephalus developing after the evacuation of a chronic SDH ranged 0 to 16% [1,2]. The incidence of pneumocephalus increases in the patients aged over 60 years and those presenting with a midline shift more than 5 mm [2].…”

“…The incidence of tension pneumocephalus developing after the evacuation of a chronic SDH ranged 0 to 16% [1,2]. The incidence of pneumocephalus increases in the patients aged over 60 years and those presenting with a midline shift more than 5 mm [2]. In the review of literature, several contributing factors including nitrous oxide anesthesia, duration of surgery, hydrocephalus, ventriculoperitoneal shunt, and intraoperative administration of mannitol are involved in the pathogenesis of tension pneumocephalus [3].Clinically, tension pneumocephalus can cause headaches, nausea, vomiting, irritability, dizziness, and seizures.…”

Series Study of Sub acute and Chronic Subdural Haematoma

“…Generous hydration of patients with intravenous fluids postoperatively was thought to increase brain volume and decrease risk of recurrence [1]. Some amount of pneumocephalus is common in immediate postoperative CT scan [9]. Tension pneumocephalus can cause worsening and may require aspiration.…”