Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: report of seven cases

Lavano, Angelo; Volpentesta, Giorgio; Donato, Giuseppe; Marotta, Rosa; Zappia, Mario; Signorelli, C D

doi:10.1016/0303-8467(90)90005-p

Cited by 25 publications

(16 citation statements)

References 30 publications

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“…This was consistent with what was reported in the literature[16–18] which stated a range from 0 to 16% for this specific complication after surgical evacuation of CSDH.…”

Section: Discussionsupporting

confidence: 93%

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

Zidan

2012

Asian J Neurosurg

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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.

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“…This was consistent with what was reported in the literature[16–18] which stated a range from 0 to 16% for this specific complication after surgical evacuation of CSDH.…”

Section: Discussionsupporting

confidence: 93%

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

Zidan

2012

Asian J Neurosurg

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“…Studies in favor of early and late mobilization A Abouzari et al [82] Kurabe et al [84] Reversal of anticoagulation Rapid reversal using PCC and Vitamin K C Woo et al [107] Resumption of anticoagulation Yeon et al [114] Chari et al [111] Reversal of antiplatelets • Failure of brain to re-expand and/or reaccumulation of blood in the subdural space (leading to recurrent cSDH) [0-30%) [129] • Seizures (including status epilepticus) (1-23%) [123,125] • Intracerebral hemorrhage (0.7-5%, especially in patients over 75 years of age, in rapid decompression of hematoma; 1/3 of the patients die and 1/3 are severely disabled) [5,[129][130][131] • Postoperative infections (e.g. wound infection, subdural empyema) (2%) [129] • Tension pneumocephalus (0-10%) [129,132,133] All complications are more common in elderly, polymorbid, and enervated patients [5]. However, a recent retrospective study evaluating the outcome in patients over 65 years of age who were treated surgically for cSDH, concluded that despite higher rates of anticoagulation and multimorbidity, surgical treatment in elderly patients is safe [134].…”

Section: Nonementioning

confidence: 99%

Evidence-Based Treatment of Chronic Subdural Hematoma

Soleman¹,

Taussky²,

Fandiño³

et al. 2014

Traumatic Brain Injury

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Addi"ional informa"ion is available a" "he end of "he chap"er h""p://dx.doi.org/10.5772/57336 . IntroductionChronic subdural hematoma cSDH is one of the most frequent neurosurgical entities caused by head trauma. Since cSDH affects mainly elderly patients and the population continues to age, it has become a common neurosurgical disease seen by both general and specialized health-care practitioners. Despite the increasing prevalence of cSDH, class I studies, and evidence regarding the management of this disease is lacking. We provide an overview of the epidemiology, pathophysiology and etiology of cSDH and discuss several controversial aspects of its management including indication and timing of surgery, steroid treatment, the effectiveness of anti-epileptic prophylaxis, comparative effectiveness of various techniques for surgical evacuation, the timing of postoperative resumption of anticoagulant medication, and protocols for mobilization following evacuation of cSDH. Complications of surgical evacuation such as recurrent hematoma, postoperative epilepsy, brain injury and/or iatrogenic intracerebral bleeding due to hematoma evacuation, drainage insertion or irrigation, and ways to avoid them are also discussed. "s the incidence of cSDH is expected to increase and most treatment aspects lack clear consensus, further large prospective studies are needed. For this reason, a randomized, prospective study evaluating one aspect of the management of cSDH is currently in progress at our institution.. Definition " chronic subdural hematoma cSDH is defined as chronic ≥ weeks intracranial bleeding between the dura mater which adheres to the skull , and the arachnoid mater which envelops © 2014 Soleman e" al.; licensee InTech. This is a paper dis"rib""ed "nder "he "erms of "he Crea"ive Commons A""rib""ion License (h""p://crea"ivecommons.org/licenses/by/3.0), which permi"s "nres"ric"ed "se, dis"rib""ion, and reprod"c"ion in any medi"m, provided "he original work is properly ci"ed. the brain . The underlying cause of cSDH is usually traumatic tearing of the bridging veins which connect the brain surface with the dura mater.[ ]. . EpidemiologyThe incidence of cSDH is estimated at . -per ' people, rising up to per ' people in patients above the age of [ -]. The average age of patients with cSDH is approximately years old [ ]. "s the population continues to mature, incidence is expected to double by the year [ , ]. " large demographic study found the prevalence of cSDH in patients older than to be significantly higher % vs. % [ ]. In addition, men are more frequently affected than women % vs. % . In % of the cases, the patient has suffered a fall in the past and % of the patients were either treated with oral anticoagulants or platelet aggregation inhibitors. The reported recurrence rates range from . % to % [ -]. The most common risk factors are advanced age, alcohol abuse, seizures, cerebrospinal fluid CSF shunts, coagulopathies, blood thinners, and patients at risk for falling e.g. hemiplegia . In -% of the cases, cSDHs are b...

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“…In human beings, suggested risk factors for development of postoperative tension pneumocephalus include: the use of nitrous oxide anaesthesia, prolonged duration of surgery, the presence of gross hydrocephalus, a functional ventriculoperitoneal shunt and intraoperative mannitol administration (Marras and others 1998, Satapathy and Dash 2000, Prabhakar and others 2003). Pneumocephalus resulting from procedures other than craniotomy or craniectomy have been reported (Wohlgemuth 1985, Andrews and Canalis 1986, Tanaka and others 1986, Schwarz and Tritthart 1987, Ishiwata and others 1988, Lavano and others 1992, Villarejo and others 1998, Gonul and others 2000, Shehu and Ismail 2002). Pneumorrhachis or air within the spinal canal is an extremely uncommon complication observed in human beings after intracranial surgery (Prabhakar and others 2006).…”

Section: Introductionmentioning

confidence: 99%

Intraventricular tension pneumocephalus and cervical subarachnoid pneumorrhachis in a bull mastiff dog after craniotomy

Cavanaugh

Aiken

Schatzberg

2008

J of Small Animal Practice

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An eight-year-old bull mastiff dog underwent a craniotomy for surgical excision of an olfactory lobe meningioma. Rapidly progressive neurological deficits with cervical pain developed within the early postoperative period. Intraventricular and cervical subarachnoid space air accumulation (pneumorrhachis) was identified through magnetic resonance imaging and computed tomography. Repair of a dural defect using synthetic dura substitute resulted in gradual resolution of neurological signs attributable to the tension pneumocephalus and subarachnoid space pneumorrhachis. Regrowth of the meningioma was not observed. Postoperative intraventricular tension pneumocephalus and air accumulation within subarachnoid space are uncommon but life-threatening complications of intracranial surgery. Early diagnosis and treatment can result in a satisfactory outcome.

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Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: report of seven cases

Cited by 25 publications

References 30 publications

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

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

Evidence-Based Treatment of Chronic Subdural Hematoma

Intraventricular tension pneumocephalus and cervical subarachnoid pneumorrhachis in a bull mastiff dog after craniotomy

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