Subdural Pneumocephalus Aspiration Reduces Recurrence of Chronic Subdural Hematoma. 2020

Vamsidhar Chavakula, and Sandra C Yan, and Kevin T Huang, and Jingyi Liu, and Wenya Linda Bi, and Peter Rozman, and John H Chi
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Chronic subdural hematoma (cSDH) is a common neurosurgical condition, with symptoms ranging from headaches to coma. Operative evacuation is the treatment of choice. Subdural reaccumulation leading to reoperation is a vexing postoperative complication. To present a novel technique for intraoperative aspiration of pneumocephalus via a subdural drain following SDH evacuation as a method of reducing potential subdural space and promoting cerebral expansion, thereby decreasing SDH recurrence. In this retrospective study, 15 patients who underwent operative evacuation of cSDH between 2008 and 2015 were assessed. Six patients underwent a small craniotomy with intraoperative pneumocephalus aspiration. These patients were matched by age, gender, and anticoagulation status to 9 patients who underwent evacuation of SDH without pneumocephalus aspiration. Quantitative volumetric analysis was performed on the preoperative, postoperative, and 1-mo follow-up computed tomography scan to assess the subdural volume. In the immediate postoperative period, there was no difference in the percentage of residual subdural fluid between the aspiration and control groups (0.291 vs 0.251; P = 1.00). There was a decrease in amount of pneumocephalus present when the aspiration technique was applied (0.182 vs 0.386; P = .041). At 1-mo follow-up, there was a decrease in the residual cSDH volume between the aspiration and the control groups (28.7 mL vs 60.8 mL; P = .011). The long-term evacuation rate was greater in the aspiration group (75.4% vs 51.6%; P = .015). Intraoperative aspiration of cSDH cavity is a safe technique that may enhance cerebral expansion and reduce likelihood of cSDH recurrence.

UI MeSH Term Description Entries
D011007 Pneumocephalus Presence of air or gas within the intracranial cavity (e.g., epidural space, subdural space, intracerebral, etc.) which may result from traumatic injuries, fistulous tract formation, erosions of the skull from NEOPLASMS or infection, NEUROSURGICAL PROCEDURES, and other conditions. Cranial Pneumocyst,Intracranial Gas,Pneumocephalus, Tension,Cranial Airocele,Pneumocephalus, Epidural,Pneumocephalus, Traumatic,Pressure Pneumocephalus,Airocele, Cranial,Airoceles, Cranial,Cranial Airoceles,Cranial Pneumocysts,Epidural Pneumocephalus,Gas, Intracranial,Pneumocephalus, Pressure,Pneumocyst, Cranial,Pneumocysts, Cranial,Tension Pneumocephalus,Traumatic Pneumocephalus
D003399 Craniotomy Surgical incision into the cranium. Craniectomy,Craniectomies,Craniotomies
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D013355 Subdural Space Potential cavity which separates the ARACHNOID MATER from the DURA MATER. Space, Subdural,Subdural Spaces
D020200 Hematoma, Subdural, Chronic Accumulation of blood in the SUBDURAL SPACE with delayed onset of neurological symptoms. Symptoms may include loss of consciousness, severe HEADACHE, and deteriorating mental status. Hemorrhage, Subdural, Chronic,Subdural Hematoma, Chronic,Chronic Subdural Hematoma,Chronic Subdural Hematomas,Hematoma, Chronic Subdural,Hematomas, Chronic Subdural,Subdural Hematomas, Chronic

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