Neurological research · 2026
Postoperative pneumocephalus in unilateral chronic subdural hematoma and its correlation with recurrence: a retrospective single-center study.
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Liebert Adrian, Eibl Thomas, Ritter Leonard, Schebesch Karl-Michael
Аннотация
OBJECTIVES: Pneumocephalus emerged as a risk factor for recurrence of chronic subdural hematoma (CSDH). However, data on volumetric assessment of subdural air (SA), its risk factors, and correlation with recurrence remain limited.
MATERIALS AND METHODS: We retrospectively included patients with unilateral CSDH who underwent surgery. Three analyses were performed: (1) comparison of absolute versus relative SA to preoperative hematoma volume (HV) for predicting recurrence; (2) evaluation of the relationship between SA and recurrence using regression and stratification into four SA-volume subgroups; (3) identification of risk factors for pneumocephalus.Recurrence was defined as symptomatic re-accumulation of CSDH requiring re-surgery within the first three months of surgery.
RESULTS: 142 patients were included. Absolute SA demonstrated a stronger correlation with recurrence, with a cut-off value of 6.95 ml. Each additional 1 ml of SA was associated with a 4.3% increase in the odds of recurrence, and rates ranged from 12.4% in patients (<7 ml) to 45% (>21 ml) (p < 0.001). Patients with ≥7 ml of SA were older (p = 0.04), more frequently had hemispheric hematomas (p = 0.02), and exhibited greater mass effect, reflected by width, HV, and midline shift (all p < 0.001). Multivariate analysis and ROC-analysis revealed preoperative HV ≥ 105.5 ml as a relevant parameter of increased SA (p < 0.001).
CONCLUSION: Preoperative HV demonstrated strongest relation to elevated postoperative SA. Absolute postoperative SA correlates better with recurrence. Patients with ≤6.95 ml of SA have a lower recurrence risk, whereas higher volumes are associated with progressively increased recurrence.
MATERIALS AND METHODS: We retrospectively included patients with unilateral CSDH who underwent surgery. Three analyses were performed: (1) comparison of absolute versus relative SA to preoperative hematoma volume (HV) for predicting recurrence; (2) evaluation of the relationship between SA and recurrence using regression and stratification into four SA-volume subgroups; (3) identification of risk factors for pneumocephalus.Recurrence was defined as symptomatic re-accumulation of CSDH requiring re-surgery within the first three months of surgery.
RESULTS: 142 patients were included. Absolute SA demonstrated a stronger correlation with recurrence, with a cut-off value of 6.95 ml. Each additional 1 ml of SA was associated with a 4.3% increase in the odds of recurrence, and rates ranged from 12.4% in patients (<7 ml) to 45% (>21 ml) (p < 0.001). Patients with ≥7 ml of SA were older (p = 0.04), more frequently had hemispheric hematomas (p = 0.02), and exhibited greater mass effect, reflected by width, HV, and midline shift (all p < 0.001). Multivariate analysis and ROC-analysis revealed preoperative HV ≥ 105.5 ml as a relevant parameter of increased SA (p < 0.001).
CONCLUSION: Preoperative HV demonstrated strongest relation to elevated postoperative SA. Absolute postoperative SA correlates better with recurrence. Patients with ≤6.95 ml of SA have a lower recurrence risk, whereas higher volumes are associated with progressively increased recurrence.