Incidence and Risk Factors of Chronic Subdural Hematoma after Endoscopic Endonasal Surgery

Background: Endoscopic endonasal surgery (EES) is a less invasive approach for treating skull base lesions, but its association with chronic subdural hematoma (CSDH) remains unclear.

Objective: To determine the incidence of CSDH following EES and identify associated risk factors, focusing on postoperative pneumocephalus.

Methods: We retrospectively analyzed 159 patients who underwent EES with intradural exposure. Patient demographics, surgical details, and radiological findings were collected. Statistical analyses were performed to assess risk factors and predictive values.

Results: CSDH occurred in 3.8% of patients, with a 0.6% rate of symptomatic CSDH. Larger convexity pneumocephalus on immediate postoperative CT was significantly associated with subsequent CSDH development (p < 0.001). A cutoff value of 10 cm² for the product of diameter and thickness of convexity pneumocephalus on CT was identified as a predictor of CSDH development (sensitivity 0.82, specificity 0.74). Preoperative subdural space thickness of ≥5 mm and posterior skull base dural defect were also marginally significant risk factors.

Conclusion: While CSDH is a rare complication following EES, with larger postoperative convexity pneumocephalus as a significant risk factor.

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Publication History

Article published online:
05 February 2024