Pseudohypoxic Brain Swelling: A Newly Defined Complication after Uneventful Brain Surgery, Probably Related to Suction Drainage

Dirk Van Roost, Christof Thees, Christopher Brenke, Falk Oppel, Peter A. Winkler, Johannes Schramm, Frank Hsu, Robert F. Spetzler, Ivan S. Ciric, Alexander R. Shakhnovich, Alexander N. Konovalov, Robert G. Grossman

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


OBJECTIVE: This is the first description of a severe and sometimes fatal complication after uneventful intracranial surgery. The clinical presentation and imaging features mimic those of global cerebral hypoxia. Extensive investigations were performed to discover the pathogenesis. METHODS: Seventeen cases of pseudohypoxic brain swelling (PHBS) were collected from our institution and from various other neurosurgical departments and were studied for common features. PHBS can occur in a mild, moderate, or severe degree. It is characterized by a very early postoperative onset of clinical deterioration (clouded or lost consciousness and pupillary abnormalities), in association with typical bilateral computed tomographic or magnetic resonance imaging changes (hypodensities or altered intensities in the basal ganglia and/or thalamus). The following variables were considered: age, primary pathological lesion and intracranial location, previous cranial surgery, anesthetic risk, type of anesthesia, approach and duration of surgery, intraoperative observations, technical monitoring results, and blood gas analyses. The results of postoperative computed tomography and various other imaging studies, intracranial pressure measurements, transcranial Doppler sonography, toxicological analyses, brain and muscle biopsies, and autopsies were also considered in the investigation. Several countermeasures were instituted and evaluated. RESULTS: Anoxemic and ischemic hypoxia was excluded as a cause of PHBS. No evidence was found for inhibition of the respiratory chain, mitochondriopathy, poisoning, or adverse effects of drugs. CONCLUSION: Indications of intracranial hypotension, induced by suction drainage, being the main pathomechanism of PHBS are discussed. A serious warning is issued regarding the use of suction drainage after intracranial surgery.

Original languageEnglish (US)
Pages (from-to)1315-1327
Number of pages13
Issue number6
StatePublished - Dec 2003


  • Basal ganglia
  • Brain edema
  • Complication
  • Hypoxia
  • Suction drainage
  • Sudden death

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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