Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Commentary
10 (
1
); 120-121
doi:
10.4103/jnrp.jnrp_313_18

Commentary

Mito Medical Center, Faculty of Medicine, Tsukuba University Hospital, University of Tsukuba, Mito Kyodo Hospital, Mito, Ibaraki, Japan
Address for correspondence: Dr. Ryota Mashiko, Mito Medical Center, Faculty of Medicine, Tsukuba University Hospital, University of Tsukuba, Mito Kyodo Hospital, 3-2-7 Miya-Mahci, Mito 310-0015, Ibaraki, Japan. E-mail: ryotamashiko@ybb.ne.jp

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Several methods[12] have been proposed to reduce postsurgical intracranial residual air, “pneumocephalus,” in chronic subdural hematoma, and postoperative pneumocephalus is thought to relate to higher recurrence rates.[3] Furthermore, tension pneumocephalus has been reported repeatedly.[4] Despite these points, some authors believe that postoperative pneumocephalus is not serious.[5] I also believe that the small amount of residual intracranial air may not lead to serious complications.

To minimize intracranial air, it is indispensable and most essential to keep the burr hole at the highest point during the surgery, which is a common and basic method described widely in major texts books.[67] I believe that massive intracranial air exiting postoperatively principally depends on inadequate intraoperative burr-hole position. Exceptions include the small number of patients in whom adequate positioning of the burr hole cannot be obtained because of stiff neck or restless conditions. Patients requiring emergent simultaneous drainage of bilateral hematomas are also in this category.

Detailed descriptions on how to keep the burr hole at the highest position are not found in current texts. I use the following method: First, patients are positioned in a motorized bed with their head rotated to the contralateral side. Two dorsal plates are set ventrally to avoid patients slipping downward intraoperatively, and most of the operation is performed with patients in the flat supine position. After inserting the drainage tube and irrigating the hematoma, we rotate the bed to the contralateral side and elevate the patient's head to keep the burr hole at the highest position. We inject saline through the drainage tube to eject the remaining air then the skin is closed, and the patient is returned to the flat supine position. Using this approach, I have not experienced residual massive intracranial air.

The authors propose a new method of safely evacuating air during surgery for chronic subdural hematoma in the article “Burr-Hole Evacuation of Chronic Subdural Hematoma: Biophysically and Evidence-Based Technique Improvement” published in the current issue of Journal of Neurosciences in Rural Practice.[8] The authors also discuss a perioperative and intraoperative therapeutic strategy in detail and declare the safety of their method.

I have the following concerns: the method the authors used intraoperatively inserting two drains is associated with potential serious risk, which is not described in the paper. During saline injection into the hematoma cavity, blockage of the front tube with clots may lead to intracranial hypertension. Therefore, the authors’ method has additional risks compared with simple irrigation and drainage and should be confined to patients in whom adequate positioning of the burr holes cannot be maintained.

REFERENCES

  1. , , , , , , . Carbon dioxide gas replacement of chronic subdural hematoma using single burr-hole irrigation. Surg Neurol. 1995;43:574-7.
    [Google Scholar]
  2. , , , . Tension pneumocephalus after evacuation of chronic subdural hematoma and subsequent treatment with continuous lumbar subarachnoid infusion and craniostomy drainage. Neurosurgery. 1985;16:107-10.
    [Google Scholar]
  3. , , . Postoperative pneumocephalus increases the recurrence rate of chronic subdural hematoma. Clin Neurol Neurosurg. 2018;166:56-60.
    [Google Scholar]
  4. , , , , , . Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report. Surg Neurol Int. 2010;1:pii: 27.
    [Google Scholar]
  5. , . Pneumocephalus after surgical evacuation of chronic subdural hematoma: Is it a serious complication? Asian J Neurosurg. 2012;7:66-74.
    [Google Scholar]
  6. , , , . Surgical management of chronic subdural hematoma in adults. In: , ed. Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, Results (6th ed). Philadelphia: Elsevier; . p. :246-56.
    [Google Scholar]
  7. , . Chronic subdural hematoma. In: , ed. Handbook of Neurosurgery (8th ed). New York: Thieme; . p. :898-901.
    [Google Scholar]
  8. , , , , . Burr-hole evacuation of chronic subdural hematoma: Biophysically and evidence based technique improvement. J Neurosci Rural Pract. 2018;10:113-8.
    [Google Scholar]

    Fulltext Views
    282

    PDF downloads
    361
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections