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A Novel Technique for Eliminating Pneumocephalus in Chronic Subdural Hematoma Burr-hole Surgery
Jiankuai Zhou1, Huimin Shen1, Jianchen Jin1
1Department of Neurosurgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, China.
Insights
This study introduces a new surgical technique to eliminate air (pneumocephalus) after chronic subdural hematoma (cSDH) surgery. The method effectively reduced air and shows potential for lowering cSDH recurrence rates.
Area of Science:
- Neurosurgery
- Medical Technology
Background:
- Chronic subdural hematoma (cSDH) is increasingly common in elderly patients.
- Burr-hole surgery is the standard treatment for cSDH.
- Pneumocephalus, or air in the subdural space, is a complication that can lead to cSDH recurrence.
Purpose of the Study:
- To describe a novel surgical technique using a subdural catheter to eliminate pneumocephalus after cSDH evacuation.
- To assess the technique's efficacy in reducing the subdural potential space and decreasing cSDH recurrence.
Main Methods:
- A retrospective study of 52 patients undergoing burr-hole evacuation of cSDH.
- Ten patients received a modified technique for intraoperative pneumocephalus elimination.
- Quantitative volumetric analysis of CT scans was used to measure pneumocephalus volume.
Main Results:
- The novel technique significantly decreased postoperative pneumocephalus volume (5.6 mL vs. 16.6 mL) and subdural air ratio (0.05 vs. 0.19) on postoperative day 1.
- While the recurrence rate was lower in the technique group at three months (0.0% vs. 4.7%), this did not reach statistical significance.
Conclusions:
- An innovative surgical technique effectively eliminates subdural air during cSDH burr-hole surgery.
- This streamlined approach simplifies the procedure and shows promise in reducing cSDH recurrence.
Background:
Chronic subdural hematoma (cSDH) is a common neurosurgical condition with increasing prevalence in the aged population. Burr-hole surgery is the most common and effective treatment. However, subsequent pneumocephalus is a complication and has been a cause leading to recurrence and reoperation. This study aims to describe a novel technique to eliminate pneumocephalus via subdural catheter following subdural hematoma evacuation, as a method to reduce subdural potential space and decrease recurrence.
Methods:
In this retrospective study, 52 patients who underwent burr-hole craniotomy evacuation of cSDH between January 2023 and September 2024 were assessed. Ten patients underwent modified intraoperative pneumocephalus elimination. Quantitative volumetric analysis was performed on preoperative, postoperative, and one-month follow-up computed tomography scans to assess the volume of pneumocephalus.
Results:
There were no differences in baseline characteristics between the present technique and control groups. The present technique resulted in decreased pneumocephalus volume (5.6 mL vs 16.6 mL; P = .035) and subdural air ratio (0.05 vs 0.19; P = .010) on post-operative day 1. At three-month follow-up, the recurrence rate was lower in the present technique group, though this difference did not reach statistical significance (0.0% vs 4.7%; P = 1.000).
Conclusion:
In conclusion, we present an innovative surgical technique that demonstrates remarkable efficacy in eliminating subdural air during cSDH burr-hole surgery. This technique offers a safe, streamlined approach that not only simplifies the surgical procedure but also shows promise in reducing cSDH recurrence rates.
