Du Xiaolin, Zhou Kun, Wang Cheng, Chen Junquan, Yang Hua
Department of Neurosurgery, The Jinyang Hospital Affiliated to Guizhou Medical University, Guiyang, Guizhou Province, China.
Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China.
J Clin Neurosci. 2025 Jul;137:111275. doi: 10.1016/j.jocn.2025.111275. Epub 2025 May 8.
Symptomatic chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition predominantly managed through burr hole drainage. Postoperatively, pneumocephalus frequently manifests in CSDH cases, and in some instances, tension pneumocephalus may evolve into a life-threatening complication. Despite several studies examining the association between pneumocephalus and recurrence, the outcomes have remained inconclusive.
An extensive literature review was carried out utilizing PubMed, EmBase, Web of Science (including Medline), and the Cochrane Library for literature available until September 2024. Studies concerning the association between pneumocephalus and recurrence were identified. Utilizing the PRISMA guidelines, titles, abstracts, and full texts of the selected studies were examined, with articles gradually excluded based on predefined criteria. Data extracted from these studies were processed through RevMan 5.4 software. The primary outcome assessed was hematoma recurrence, while secondary outcomes involved prognosis and mortality rate.
The analysis incorporated nineteen investigations, involving an aggregate of 3,202 individuals with confirmed CSDH diagnoses. The findings indicated that the recurrence rate (RR) in the pneumocephalus group was markedly higher in comparison to the control group (OR, 3.22; 95 % CI, 2.47-4.20, P < 0.00001). The subgroup with extensive pneumocephalus presented a notably higher RR compared to the no/minimal pneumocephalus subgroup (P < 0.00001). Furthermore, the massive pneumocephalus subgroup exhibited a higher RR when contrasted with the no/minimal/moderate pneumocephalus group (P < 0.00001). In addition, the massive pneumocephalus subgroup demonstrated a higher RR compared to the moderate pneumocephalus subgroup (P = 0.003). Nevertheless, no statistically significant variation in RR was identified between the moderate pneumocephalus and no/minimal pneumocephalus groups (P = 0.34). The analysis also demonstrated that outcomes in the pneumocephalus group were poorer when compared with the control group (OR, 0.18; 95 % CI, 0.09-0.35, P < 0.00001). Conversely, no statistically significant difference in mortality rates between the pneumocephalus and control groups (P = 0.67).
The recurrence of CSDH is linked to the volume of postoperative pneumocephalus. While small or moderate volumes of pneumocephalus do not influence the RR of CSDH, extensive pneumocephalus is considered a marked risk factor for postoperative recurrence in individuals with CSDH. Although pneumocephalus does not appear to affect mortality rates, it has a notable impact on the prognosis of CSDH. These conclusions necessitate further confirmation through large-scale, meticulously designed prospective studies.
有症状的慢性硬膜下血肿（CSDH）是一种常见的神经外科疾病，主要通过钻孔引流进行治疗。术后，气颅在CSDH病例中经常出现，在某些情况下，张力性气颅可能演变成危及生命的并发症。尽管有多项研究探讨了气颅与复发之间的关联，但其结果仍无定论。
利用PubMed、EmBase、科学网（包括Medline）和Cochrane图书馆对截至2024年9月的可用文献进行了广泛的文献综述。确定了有关气颅与复发之间关联的研究。根据PRISMA指南，对所选研究的标题、摘要和全文进行了审查，并根据预定义标准逐步排除文章。从这些研究中提取的数据通过RevMan 5.4软件进行处理。评估的主要结果是血肿复发，次要结果包括预后和死亡率。
该分析纳入了19项研究，共涉及3202例确诊为CSDH的个体。结果表明，气颅组的复发率（RR）明显高于对照组（OR，3.22；95%CI，2.47 - 4.20，P < 0.00001）。广泛性气颅亚组的RR明显高于无/少量气颅亚组（P < 0.00001）。此外，大量气颅亚组与无/少量/中度气颅组相比，RR更高（P < 0.00001）。另外，大量气颅亚组与中度气颅亚组相比，RR更高（P = 0.003）。然而，中度气颅组与无/少量气颅组之间的RR没有统计学上的显著差异（P = 0.34）。分析还表明，气颅组的预后与对照组相比更差（OR，0.18；95%CI，0.09 - 0.35，P < 0.00001）。相反，气颅组与对照组之间的死亡率没有统计学上的显著差异（P = 0.67）。
CSDH的复发与术后气颅的体积有关。虽然少量或中度气颅不影响CSDH的RR，但广泛性气颅被认为是CSDH患者术后复发的显著危险因素。尽管气颅似乎不影响死亡率，但它对CSDH的预后有显著影响。这些结论需要通过大规模、精心设计的前瞻性研究进一步证实。
