Immediate pneumothorax after neurosurgical procedures.
OBJECTIVE
Pneumothorax after neurosurgical procedures is very rare and incompletely understood. This study was performed to explore the clinical characteristics and pathogenesis of pneumothorax after neurosurgery.


METHODS
We retrospectively evaluated patients admitted from December 2016 to April 2019 for treatment of spontaneous intracranial hemorrhage. The inclusion criteria were neurosurgical procedures (open surgeries or endovascular intervention) performed under general anesthesia, no performance of central venous puncture during surgery, and occurrence of pneumothorax immediately after the neurosurgical procedure.


RESULTS
Eight patients developed pneumothorax after neurosurgical procedures for spontaneous intracranial hemorrhage under general anesthesia. Of the eight patients, seven had aneurysmal subarachnoid hemorrhage and one had left temporal-parietal hemorrhage. The lung injury prediction score (LIPS) was 3, 4, 5, 6, and 9.5 in three, one, two, one, and one patient, respectively. During the operation, volume-controlled ventilation (tidal volume, 8-10 mL/kg) was selected for all patients.


CONCLUSIONS
Neurogenic pulmonary edema, inappropriate mechanical ventilation, and stimulation by endotracheal intubation might conjointly contribute to postoperative pneumothorax. To avoid this rare entity, mechanical ventilation with a low tidal volume or low pressure during general anesthesia should be adopted for patients with hemorrhagic cerebrovascular diseases involving the temporal lobe and a LIPS of >3.
['Zhang|Jinzhu|J|', 'Xu|Kan|K|', 'Chen|Xuan|X|', 'Qi|Bin|B|', 'Hou|Kun|K|https://orcid.org/0000-0001-7112-7883', 'Yu|Jinlu|J|https://orcid.org/0000-0003-2329-7946']
D000328:Adult D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D019635:Neurosurgical Procedures D011030:Pneumothorax D012121:Respiration, Artificial D012189:Retrospective Studies D013990:Tidal Volume
pneumothorax Neurosurgical procedure lung injury lung injury prediction score neurogenic pulmonary edema mechanical ventilation thoracic closed drainage