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

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