Multidisciplinary Management of Bilateral Pneumocephalus after Burr Hole Surgery: A Case Report

Postoperative pneumocephalus is a common complication following burr hole surgery, particularly in older adults with cerebral atrophy. Although often self-limiting, its management may be challenging in patients with complex comorbidities. We report a 74-year-old woman with Parkinson's disease, ischemic stroke, and dementia who underwent bilateral burr hole drainage for subdural effusion and hematoma. Postoperatively, she developed bilateral pneumocephalus with persistent impaired consciousness. High-flow nasal cannula oxygen therapy was initiated, resulting in a marked reduction of intracranial air and considerable neurological improvement. This case highlights that high-flow nasal cannula oxygen therapy is a safe and effective strategy for managing postoperative pneumocephalus in older adults with multiple neurological comorbidities and underscores the importance of individualized treatment planning in complex neurosurgical cases.