Postoperative Subdural Air Collection Is a Risk Factor for Chronic Subdural Hematoma after Surgical Clipping of Cerebral Aneurysms

The precise mechanism of the development of chronic subdural hematoma (CSDH) as a postoperative complication after aneurysmal clipping remains unclear. The purpose of this study was to identify the independent risk factors for CSDH after craniotomy for aneurysmal clipping and to elucidate the relationship between CSDH and subdural air (SDA) collection immediately after surgery. The medical records and radiologic data of 344 patients who underwent surgical clipping of unruptured aneurysms from July 2010 to July 2016 were retrospectively evaluated. Patient characteristics, aneurysm characteristics, and operation data were statistically analyzed to reveal their relationships with CSDH development. Among the 344 patients, 46 (13.4%) developed CSDH and 13 (3.8%) required subsequent burr-hole surgery for evacuation and irrigation. Multivariate analyses showed that advanced age (P < 0.0001), male sex (P = 0.035), and surgical clipping of multiple aneurysms (P = 0.037) were independent preoperative predictors of CSDH development. Advanced age (P = 0.0005) and postoperative SDA after clipping surgery (P < 0.0001) were independent postoperative predictors of CSDH development. Postoperative SDA and CSDH were not associated with the individual surgeon or operation time. Postoperative severe SDA was significantly associated with the ipsilateral development of CSDH, irrespective of the side of craniotomy. Postoperative SDA is an independent risk factor for CSDH after surgical clipping of unruptured aneurysms and is as important as advanced age, male sex, and surgical clipping of multiple aneurysms in predicting CSDH.