To analyze the factors associated with sudden changes in pupil size in neurosurgical perioperative patients and evaluate the necessity of repeat head CT scans.

A retrospective collection was conducted of 29 cases of sudden postoperative pupil changes in neurosurgical patients treated at Neurosurgery Department of Xuanwu Hospital, Capital Medical University from December 2020 to January 2024. The control group consisted of 29 neurosurgical patients who underwent routine postoperative head CT scans during the same period without any changes in pupil size. Clinical data were collected, and both univariate and multivariate Logistic regression analyses were performed to identify potential influencing factors for postoperative pupil changes.

There was no significant difference in general data between the group of patients with pupil changes and the group without pupil changes (P>0.05). Univariate Logistic analysis indicated no significant association between sudden pupil changes and factors such as gender, tracheal intubation with sedation and analgesia, the use of ipratropium bromide nebulization inhalation and intracranial disease changes, however, changes in consciousness and clinical intervention were significantly associated with sudden pupil changes. Multivariate Logistic analysis revealed that changes in consciousness and the need for clinical intervention were independent risk factors for detecting pupil changes.

Following perioperative pupil changes, accompanying changes in consciousness and the need for clinical intervention are significant risk factors. It is necessary to urgently review the head CT and develop personalized treatment plans for the patients.