J Neurol Surg A Cent Eur Neurosurg 2022; 83(02): 206-209
DOI: 10.1055/s-0041-1730963
Case Report

Fatal Acute Pneumocephalus after Bilateral Drainage for Chronic Subdural Hematomas: Case Report

Milan Lepić
1   Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
2   Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
3   Faculty of Medicine, University of Belgrade, Belgrade, Serbia
,
Stefan Mandić-Rajčević
4   School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
,
Goran Pavlićević
1   Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
2   Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
,
Radomir Benović
2   Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
,
Nenad Novaković
1   Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
2   Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
,
Lukas Rasulić
3   Faculty of Medicine, University of Belgrade, Belgrade, Serbia
5   Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
› Author Affiliations

Abstract

Background Pneumocephalus is a well-known complication in the surgical treatment of chronic subdural hematomas; however, its influence remains controversial. The amount of subdural air may vary, and it may cause worsening of symptoms, increase reoccurrence rates, and worsen the outcomes. Lethal outcome following acute onset of massive pneumocephalus was not previously reported.

Case Report An 81-year-old man with bilateral hematomas underwent surgery under local anesthesia. Both hematomas were approached in the same surgery, and the drains were placed subdurally. After initial improvement, severe hypertension developed, followed by vital function and neurologic deterioration. Massive pneumocephalus with subarachnoid and contralateral intracerebral hemorrhage was revealed, causing a severe midsagittal shift. Emergency irrigation to evacuate subdural air was performed. However, there was no improvement. Further computed tomography confirmed subdural air collection, but it also revealed hemorrhage progression and intraventricular propagation. No further surgery was indicated.

Conclusion Pneumocephalus is an underestimated but potentially devastating complication. Both intraoperative avoidance and postoperative prevention should be utilized to avoid subdural air ingress, and thus evade potentially fatal complications.



Publication History

Received: 19 August 2020

Accepted: 16 December 2020

Article published online:
14 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 You CG, Zheng XS. Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma. Clin Neurol Neurosurg 2018; 166: 56-60
  • 2 Shen J, Yuan L, Ge R. et al. Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study. Injury 2019; 50 (10) 1634-1640
  • 3 Lepic M, Mandic-Rajĉevic S, Pavlicevic G. et al. Sitting position awake craniostomy with drainage for chronic subdural hematoma: a viable alternative?. Vojnosanit Pregl 2019; xx: 93-93
  • 4 Májovský M, Netuka D, Beneš V, Kučera P. Burr-hole evacuation of chronic subdural hematoma: biophysically and evidence-based technique improvement. J Neurosci Rural Pract 2019; 10 (01) 113-118
  • 5 Chavakula V, Yan SC, Huang KT. et al. Subdural pneumocephalus aspiration reduces recurrence of chronic subdural hematoma. Operative Neurosurgery 2020; 18 (04) 391-397
  • 6 Huang GH, Li XC, Ren L. et al. Take it seriously or not: postoperative pneumocephalus in CSDH patients?. Br J Neurosurg 2020; 34 (03) 284-289
  • 7 Shen J, Gao Y, Li Q. et al. Risk factors predicting recurrence of bilateral chronic subdural hematomas after initial bilateral evacuation. World Neurosurg 2019; 130: e133-e139
  • 8 Andersen-Ranberg NC, Debrabant B, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. The Danish chronic subdural hematoma study-predicting recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2019; 161 (05) 885-894
  • 9 Schucht P, Fischer U, Fung C. et al. Follow-up computed tomography after evacuation of chronic subdural hematoma. N Engl J Med 2019; 380 (12) 1186-1187
  • 10 Aoki N. Percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. Neurol Res 1987; 9 (01) 19-23
  • 11 Aoki N, Sakai T. Computed tomography features immediately after replacement of haematoma with oxygen through percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. Acta Neurochir (Wien) 1993; 120 (1–2): 44-46
  • 12 Májovský M, Netuka D. Chronic subdural hematoma: review article. Rozhl Chir 2018; 97 (06) 253-257
  • 13 Cecchini G. Avoiding pneumocephalus after chronic subdural hematoma evacuation: the temporary double drainage technique. J Neurol Disord 2015; 1: s1
  • 14 Ihab Z. Pneumocephalus after surgical evacuation of chronic subdural hematoma: Is it a serious complication?. Asian J Neurosurg 2012; 7 (02) 66-74
  • 15 Dabdoub CB, Salas G, Silveira EdoN, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int 2015; 6: 155
  • 16 Kawakami Y, Tamiya T, Shimamura Y, Yokoyama Y, Chihara T. Tension pneumocephalus following surgical evacuation of chronic subdural hematoma. No Shinkei Geka 1985; 13 (08) 833-837
  • 17 Bouzarth WF, Hash CJ, Lindermuth JR. Tension pneumocephalus following surgery for subdural hematoma. J Trauma 1980; 20 (06) 460-463
  • 18 Lavano A, Benvenuti D, Volpentesta G. et al. Symptomatic tension pneumocephalus after evacuation of chronic subdural haematoma: report of seven cases. Clin Neurol Neurosurg 1990; 92 (01) 35-41
  • 19 Shaikh N, Masood I, Hanssens Y, Louon A, Hafiz A. Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: a case report. Surg Neurol Int 2010; 1: 1
  • 20 Caron JL, Worthington C, Bertrand G. Tension pneumocephalus after evacuation of chronic subdural hematoma and subsequent treatment with continuous lumbar subarachnoid infusion and craniostomy drainage. Neurosurgery 1985; 16 (01) 107-110
  • 21 Chavakula V, Yan SC, Huang KT. et al. Subdural pneumocephalus aspiration reduces recurrence of chronic subdural hematoma. Oper Neurosurg (Hagerstown) 2020; 18 (04) 391-397
  • 22 Moscote-Salazar LR, Agrawal A. Letter: Subdural pneumocephalus aspiration reduces recurrence of chronic subdural hematoma. Oper Neurosurg (Hagerstown) 2020; 18 (02) E62
  • 23 Aissaoui Y, Chkoura K, Belhachmi A, Boughalem M. Tension pneumocephalus after surgical treatment of a bilateral chronic subdural hematoma: a banal and serious complication. Ann Fr Anesth Reanim 2013; 32 (11) 796-798
  • 24 Pavlov O. Rapid evacuation of chronic subdural hematoma: a possible traumatic brain injury (TBI). Med Hypotheses 2020; 137: 109539
  • 25 Cohen-Gadol AA. Remote contralateral intraparenchymal hemorrhage after overdrainage of a chronic subdural hematoma. Int J Surg Case Rep 2013; 4 (10) 834-836