Relationship between postoperative pneumocephalus and recurrence following chronic subdural hematoma evacuation


  • Imran Altaf Khawja safdar medical college sialkot
  • Muhammad Rizwan Sarwar



Objective: Postoperative pneumocephalus has been reported as one of the possible causes of increased recurrence following burrhole evacuation of chronic subdural hematoma (ChSDH). The present study was designed to assess the relationship between postoperative pneumocephalus and recurrence following chronic subdural hematoma evacuation.

Materials and Methods: The medical records of sixty eight patients that had been operated for ChSDH evacuation with burrhole drainage were retrospectively analyzed. The area of the pneumocephalus was measured in the slice where the size of the pneumocephalus was the biggest. The patients were then divided into the recurrent and the non-recurrent groups and compared for their association with the postoperative pneumocephalus. Patients with a pneumocephalus size of > 4 cm2 and those with a size ? 4 cm2 were also compared with each other for recurrence.


Fourteen (20.6%) patients had recurrence following burrhole evacuation of ChSDH. The mean size of the pneumocephalus in the recurrent group was 7.88 ± 5.12 cm2 and in the non-recurrent group was 6.56 ± 5.56 cm2.The size of the pneumocephlus was not statistically different (p=0.42) between the two groups. We also compared patients with a pneumocephalus size of > 4 cm2 and those with a pneumocephalus size of ? 4 cm2 and again found that the relationship with recurrence was not significant (p=0.288).


We conclude that postoperative pneumocephalus is not associated with recurrence following burrhole evacuation of chronic subdural hematoma.

Keywords: Postoperative pneumocephalus, burrhole evacuation, recurrence, chronic subdural hematoma


Kanazawa T, Takahashi S, Minami Y, Jinzaki M, Toda M, Yoshida K. Prediction of postoperative recurrence of chronic subdural hematoma using quantitative volumetric analysis in conjunction with computed tomography texture analysis. J Clin Neurosci. 2020;72:270-276. doi: 10.1016/j.jocn.2019.11.019.

Mignucci-Jiménez, Giancarlo & Cruz, Alejandro & Preul, Mark & Feliciano-Valls, Caleb. Association between postoperative pneumocephalus and chronic subdural hematoma recurrence: A single-center population-based study in Puerto Rico. Interdisciplinary Neurosurgery. 2022;29:101578. doi: 10.1016/j.inat.2022.101578

Chan DYC, Cheung EYH, Hui KH, Leung CMS, Ng SCP, Mak WK, et al. ABC/2 formula for "bedside" postoperative pneumocephalus volume measurement. Chin Neurosurg J. 2022;8(1):18. doi: 10.1186/s41016-022-00287-z.

Ito S, Higuchi K. Subdural Air Increases Postoperative Recurrence of Chronic Subdural Hematoma After Initial Burr-hole Surgery Only in the Very Elderly: A Pilot Study. World Neurosurg. 2021;156:e25-e29. doi: 10.1016/j.wneu.2021.07.143.

Kim DH, Kim HS, Choi HJ, Han IH, Cho WH, Nam KH. Recurrence of the Chronic Subdural Hematoma after Burr-Hole Drainage with or without Intraoperative Saline Irrigation. Korean J Neurotrauma. 2014;10(2):101-105. doi:10.13004/kjnt.2014.10.2.101

Ohba S, Kinoshita Y, Nakagawa T, Murakami H. The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev. 2013;36(1):145-9; discussion 149-50. doi: 10.1007/s10143-012-0396-z.

Shen J, Xin W, Li Q, Gao Y, Zhang J. A Grading System For The Prediction Of Unilateral Chronic Subdural Hematoma Recurrence After Initial Single Burr Hole Evacuation. Risk Manag Healthc Policy. 2019;12:179-188. doi: 10.2147/RMHP.S222144.

Stanišic M, Pripp AH. A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence Requiring Reoperation After Initial Burr-Hole Surgery. Neurosurgery. 2017;81(5):752-760. doi: 10.1093/neuros/nyx090.

Ihab Z. Pneumocephalus after surgical evacuation of chronic subdural hematoma: Is it a serious complication? Asian J Neurosurg. 2012;7(2):66-74. doi: 10.4103/1793-5482.98647.

Beucler N. Letter to the Editor. How to reduce the recurrence rate in chronic subdural hematoma surgery. Journal of Neurosurgery. 2021;135(6):1905-1906. doi:10.3171/2021.4.JNS21884

Shiomi N, Sasajima H, Mineura K. [Relationship of postoperative residual air and recurrence in chronic subdural hematoma]. No Shinkei Geka. 2001;29(1):39-44.

Huang GH, Li XC, Ren L, Dai RX, Sun ZL, Jiang XF, et al. Take it seriously or not: postoperative pneumocephalus in CSDH patients? Br J Neurosurg. 2020;34(3):284-289. doi: 10.1080/02688697.2020.1729343.

Kang MS, Koh HS, Kwon HJ, Choi SW, Kim SH, Youm JY. Factors influencing recurrent chronic subdural hematoma after surgery. Journal of Korean Neurosurgical Society. 2007;41(1):11-5.

Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien). 2005;147(12):1249-56; discussion 1256-7. doi: 10.1007/s00701-005-0616-1.

Dudoit T, Labeyrie PE, Deryckere S, Emery E, Gaberel T. Is systematic post-operative CT scan indicated after chronic subdural hematoma surgery? A case-control study. Acta Neurochir (Wien). 2016;158(7):1241-6. doi: 10.1007/s00701-016-2820-6.

Amirjamshidi A, Abouzari M, Eftekhar B, Rashidi A, Rezaii J, et al. Outcomes and recurrence rates in chronic subdural haematoma. Br J Neurosurg. 2007;21(3):272-5. doi: 10.1080/02688690701272232.

You CG, Zheng XS. Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma. Clin Neurol Neurosurg. 2018;166:56-60. doi: 10.1016/j.clineuro.2018.01.029.

Shen J, Gao Y, Li Q, Ge R, Wang Q, Jiang X, et al. Risk Factors Predicting Recurrence of Bilateral Chronic Subdural Hematomas after Initial Bilateral Evacuation. World Neurosurg. 2019;130:e133-e139. doi: 10.1016/j.wneu.2019.06.016.






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