Journal of Neurosciences in Rural Practice

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Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 120  


Department of Neurological Surgery, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran

Date of Web Publication4-Jan-2019

Correspondence Address:
Keyvan Tayebi Meybodi
Department of Neurological Surgery, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnrp.jnrp_306_18

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How to cite this article:
Meybodi KT. Commentary. J Neurosci Rural Pract 2019;10:120

How to cite this URL:
Meybodi KT. Commentary. J Neurosci Rural Pract [serial online] 2019 [cited 2019 May 26];10:120. Available from:

Postoperative subdural air collection is one of the most important risk factors of (chronic subdural hematoma (CSDH) recurrence. Martin et al. have described an intraoperative technique for reducing postoperative subdural air collection after CSDH surgery, which may not add excessive time to the surgery and does not need any sophisticated surgical instrument.[1] Although the relative effectiveness of this technical nuance must be clarified in a well-powered randomized trial, it seems that it may work properly.

One of the main limitations of the described technique is the undesired placement of the drains, without awareness of the surgeon. The authors have proposed using an endoscope for this limitation, which may not be available ubiquitously. Use of intraoperative skull X-ray to check the amount of intracranial air after drain placement may be a justified, inexpensive solution, which is much more available than an endoscope in operative suites. Skull X-rays can detect as less as 2 mL of intracranial air.[2]

With a recurrence rate of up to 32%, CSDH is not an actually “solved” neurosurgical condition. The solution may not be to try to reduce it greatly with a big step; instead, multiple small steps may make sense. The newly described technique (if passes the trials) may be one of the steps.

   References Top

Májovský M, Netuka D, Beneš V, Kučera P. Burr-hole evacuation of chronic subdural hematoma: Biophysically and evidence-based technique improvement. J Neurosci Rural Pract 2019;10:113-8.  Back to cited text no. 1
  [Full text]  
Tran P, Reed EJ, Hahn F, Lambrecht JE, McClay JC, Omojola MF, et al. Incidence, radiographical features, and proposed mechanism for pneumocephalus from intravenous injection of air. West J Emerg Med 2010;11:180-5.  Back to cited text no. 2


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