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Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report.

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Title: Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report.
Authors: Gkantsinikoudis, Nikolaos (AUTHOR), Monioudis, Panagiotis (AUTHOR), Antoniades, Elias (AUTHOR), Tsitouras, Vassilios (AUTHOR), Magras, Ioannis (AUTHOR)
Source: International Journal of Neuroscience. Nov2025, Vol. 135 Issue 11, p1237-1242. 6p.
Subjects: Subdural hematoma, Neurosurgery, Surgical complications, Craniotomy, Hospital emergency services, Clinical deterioration, Gas embolism
Abstract: Purpose: Tension pneumocephalus (TP) represents a rare pathology characterized by constant accumulation of air in the intracranial space, being associated with increased risk of herniation, neurologic deterioration and death. Regarding neurosurgical trauma cases, TP is majorly encountered after chronic subdural hematoma evacuation. In this case report, we present a rare case of fatal postoperative TP encountered after craniotomy for evacuation of acute subdural hematoma (aSDH). Case Presentation: An 83-year old gentleman was presented to the emergency department of our hospital with impaired level of consciousness. Initial examination revealed Glascow Coma Scale (GCS) 3/15, with pupils of 3 mm bilaterally and impaired pupillary light reflex. CT scan demonstrated a large left aSDH, with significant pressure phenomena and midline shift. Patient was subjected to an uneventful evacuation of hematoma via craniotomy and a closed subgaleal drain to gravity was placed. The following day and immediately after his transfer to the CT scanner, he presented with rapid neurologic deterioration with acute onset anisocoria and finally mydriasis with fixed and dilated pupils. Postoperative CT scan showed massive TP, and the patient was transferred to the operating room for urgent left decompressive craniectomy, with no intraoperative signs of entrapped air intracranially. Finally, he remained in severe clinical status, passing away on the eighth postoperative day. Conclusion: TP represents a rare but severe neurosurgical emergency that may be also encountered after craniotomy in the acute trauma setting. Involved practitioners should be aware of this potentially fatal complication, so that early detection and proper management are conducted. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Neuroscience is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report.
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  Data: <searchLink fieldCode="AR" term="%22Gkantsinikoudis%2C+Nikolaos%22">Gkantsinikoudis, Nikolaos</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Monioudis%2C+Panagiotis%22">Monioudis, Panagiotis</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Antoniades%2C+Elias%22">Antoniades, Elias</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Tsitouras%2C+Vassilios%22">Tsitouras, Vassilios</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Magras%2C+Ioannis%22">Magras, Ioannis</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Neuroscience%22">International Journal of Neuroscience</searchLink>. Nov2025, Vol. 135 Issue 11, p1237-1242. 6p.
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  Data: <searchLink fieldCode="DE" term="%22Subdural+hematoma%22">Subdural hematoma</searchLink><br /><searchLink fieldCode="DE" term="%22Neurosurgery%22">Neurosurgery</searchLink><br /><searchLink fieldCode="DE" term="%22Surgical+complications%22">Surgical complications</searchLink><br /><searchLink fieldCode="DE" term="%22Craniotomy%22">Craniotomy</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+emergency+services%22">Hospital emergency services</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+deterioration%22">Clinical deterioration</searchLink><br /><searchLink fieldCode="DE" term="%22Gas+embolism%22">Gas embolism</searchLink>
– Name: Abstract
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  Data: Purpose: Tension pneumocephalus (TP) represents a rare pathology characterized by constant accumulation of air in the intracranial space, being associated with increased risk of herniation, neurologic deterioration and death. Regarding neurosurgical trauma cases, TP is majorly encountered after chronic subdural hematoma evacuation. In this case report, we present a rare case of fatal postoperative TP encountered after craniotomy for evacuation of acute subdural hematoma (aSDH). Case Presentation: An 83-year old gentleman was presented to the emergency department of our hospital with impaired level of consciousness. Initial examination revealed Glascow Coma Scale (GCS) 3/15, with pupils of 3 mm bilaterally and impaired pupillary light reflex. CT scan demonstrated a large left aSDH, with significant pressure phenomena and midline shift. Patient was subjected to an uneventful evacuation of hematoma via craniotomy and a closed subgaleal drain to gravity was placed. The following day and immediately after his transfer to the CT scanner, he presented with rapid neurologic deterioration with acute onset anisocoria and finally mydriasis with fixed and dilated pupils. Postoperative CT scan showed massive TP, and the patient was transferred to the operating room for urgent left decompressive craniectomy, with no intraoperative signs of entrapped air intracranially. Finally, he remained in severe clinical status, passing away on the eighth postoperative day. Conclusion: TP represents a rare but severe neurosurgical emergency that may be also encountered after craniotomy in the acute trauma setting. Involved practitioners should be aware of this potentially fatal complication, so that early detection and proper management are conducted. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of International Journal of Neuroscience is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1080/00207454.2024.2352767
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        Text: English
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      – SubjectFull: Subdural hematoma
        Type: general
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      – SubjectFull: Surgical complications
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      – SubjectFull: Clinical deterioration
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      – SubjectFull: Gas embolism
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      – TitleFull: Fatal postoperative tension pneumocephalus after acute subdural hematoma evacuation: a case report.
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              Text: Nov2025
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