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European Spine Journal : Official... Jan 2018The incidence of pneumocephalus and pneumorrhachis after spinal surgery is unknown, with a paucity of literature on this complication.
INTRODUCTION
The incidence of pneumocephalus and pneumorrhachis after spinal surgery is unknown, with a paucity of literature on this complication.
MATERIALS AND METHODS
We present the first published case of delayed onset tension pneumocephalus and pneumorrhachis associated with spinal surgery.
RESULTS
This complication occurred from a cerebro-spinal fluid (CSF) leak after posterior instrumentation removal and was successfully treated with emergent wound debridement and the formation of a CSF fistula.
CONCLUSIONS
This case illustrates that delayed post-operative tension pneumocephalus and pneumorrhachis can occur after spinal surgery in a patient with a CSF leak. It also illustrates that pneumocephalus and pneumorrhachis can be easily diagnosed with cross-sectional CT imaging. Furthermore, in a patient with rapid deterioration emergent surgical debridement may be necessary. Lastly, if the dural tear cannot be identified intra-operatively, the formalization of a CSF fistula should be considered.
PubMed: 28871507
DOI: 10.1007/s00586-017-5268-3 -
Proceedings (Baylor University. Medical... Oct 2018Pneumocephalus after trauma is not uncommon but rarely develops into tension pneumocephalus. Delayed-onset spontaneous tension pneumocephalus is rare, and delayed-onset...
Pneumocephalus after trauma is not uncommon but rarely develops into tension pneumocephalus. Delayed-onset spontaneous tension pneumocephalus is rare, and delayed-onset isolated intraparenchymal/intracerebral tension pneumocephalus is even more so. We describe a 35-year-old man who presented with urinary incontinence, left eye vision loss, and nasal discharge/cerebrospinal fluid rhinorrhea 2 months after recovering from bifrontal hemorrhagic contusions following a road traffic accident. Intraparenchymal/intracerebral tension pneumocephalus was diagnosed with computed tomography and the patient was taken for an urgent decompressive surgery along with repair of the skull base defect.
PubMed: 30949006
DOI: 10.1080/08998280.2018.1498680 -
Internal and Emergency Medicine Jun 2020
Topics: Accidental Falls; Craniocerebral Trauma; Diagnosis, Differential; Fatal Outcome; Foreign Bodies; Glasgow Coma Scale; Humans; Male; Pneumocephalus; Tomography, X-Ray Computed; Wounds, Penetrating; Young Adult
PubMed: 31893347
DOI: 10.1007/s11739-019-02262-6 -
British Journal of Neurosurgery Jun 2020Pneumocephalus is a common finding after burr-hole drainage of chronic subdural hematoma (CSDH). Its effects have not been specifically studied. A retrospective...
Pneumocephalus is a common finding after burr-hole drainage of chronic subdural hematoma (CSDH). Its effects have not been specifically studied. A retrospective analysis was performed in 140 patients with CSDH with single burr-hole drainage. The pre- and postoperative volumes of intracranial hematoma and the postoperative volume of pneumocephalus were calculated and analyzed with their relationships with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores. The preoperative hematoma volume and the patient ages are positively correlated with the 1-day postoperative pneumocephalus volume ( < 0.001, < 0.01). There is no correlation between postoperative pneumocephalus volume and GCS/GOS scores ( > 0.05) and there is no difference of GCS/GOS scores or CSDH recurrence rate between patients with and without pneumocephalus ( > 0.05). The age and the volume of 1-day postoperative pneumocephalus are positively correlated with the absorbing rate of pneumocephalus ( < 0.01, < 0.001). The pneumocephalus at a certain range has no effect on the prognosis of patients with CSDH and requires no specific intervention due to its self-absorbing capacity in the normal progress after surgery.HighlightsNo correlation between postoperative pneumocephalus volume and GCS/GOS scores.No difference of GCS/GOS or recurrence between patients with pneumocephalus or not.Pneumocephalus at certain range has no effect on the prognosis of patients.
Topics: Drainage; Hematoma, Subdural, Chronic; Humans; Patients; Pneumocephalus; Recurrence; Retrospective Studies; Treatment Outcome; Trephining
PubMed: 32090624
DOI: 10.1080/02688697.2020.1729343 -
Cureus Nov 2021Iatrogenic pneumocephalus and dural puncture are some causes of headache following cervical epidural injection. A 50-year-old woman presented with a sharp headache at...
Iatrogenic pneumocephalus and dural puncture are some causes of headache following cervical epidural injection. A 50-year-old woman presented with a sharp headache at the base of her skull following a cervical epidural injection for chronic neck pain. It was not relieved by lying down and was associated with nausea, vomiting, and photophobia without fever or neck rigidity. Neurological examination failed to show any abnormalities. A head CT scan showed newly evident pneumocephalus in the ventricular system and the extra-axial subarachnoid space within the sulci of the right frontal lobe. Oxygen supplementation was started with the help of a non-rebreather mask connected to 15 liters of oxygen and was slowly down titrated to room air. Repeat CT scan of the head after 48 hours showed complete resolution of the intracranial pneumocephalus. Normobaric oxygen therapy via a non-rebreather mask and a high-flow nasal cannula is effective for the treatment of intracranial pneumocephalus.
PubMed: 34963846
DOI: 10.7759/cureus.19830 -
The Journal of the Royal College of... Dec 2018
Topics: Brain Edema; Brain Injuries, Traumatic; Facial Bones; Fractures, Bone; Humans; Hydrocephalus; Intracranial Hemorrhage, Traumatic; Male; Multiple Trauma; Pneumocephalus; Tomography, X-Ray Computed; Young Adult
PubMed: 30488890
DOI: 10.4997/JRCPE.2018.411 -
International Journal of Oral and... Dec 2022Tension pneumocephalus is a rare complication of frontal sinus fracture or neurosurgical intervention resulting from compression of the brain by entrapped air, leading...
Tension pneumocephalus is a rare complication of frontal sinus fracture or neurosurgical intervention resulting from compression of the brain by entrapped air, leading to seizure, altered mental status, brain herniation, and death. This report presents a case of traumatic tension pneumocephalus associated with an anterior and posterior table frontal sinus fracture in a patient with pneumosinus dilatans and osteogenesis imperfecta.
Topics: Humans; Pneumocephalus; Skull Fractures; Mental Disorders
PubMed: 35985911
DOI: 10.1016/j.ijom.2022.07.009 -
The Neurologist Nov 2021Although pneumocephalus is very common after intracranial or spinal surgeries, pneumoventricle is uncommon. Tension pneumoventricle (tPV) occurs when air in the... (Review)
Review
INTRODUCTION
Although pneumocephalus is very common after intracranial or spinal surgeries, pneumoventricle is uncommon. Tension pneumoventricle (tPV) occurs when air in the ventricles expands to cause neurological deficits or mass effect. It is usually seen with a combination of a ball-valve defect postoperatively that sucks in air and a ventriculoperitoneal shunt that drains cerebrospinal fluid and allows the ingress of air.
CASE REPORT
A young man developed delayed tPV after surgery for craniopharyngioma. He required multiple surgeries and occlusion of the ventriculoperitoneal shunt before the tPV resolved.
CONCLUSIONS
The probable mechanisms of tPV and the importance of early recognition and treatment are discussed. A review of the literature of this uncommon entity has also been performed.
Topics: Humans; Male; Neurosurgical Procedures; Pneumocephalus; Quadriplegia; Ventriculoperitoneal Shunt
PubMed: 34842575
DOI: 10.1097/NRL.0000000000000363 -
Neurosurgical Review Feb 2020Deep brain stimulation has become an established therapeutic choice to manage the symptoms of medically refractory Parkinson's disease. Its efficacy is highly dependent... (Review)
Review
Deep brain stimulation has become an established therapeutic choice to manage the symptoms of medically refractory Parkinson's disease. Its efficacy is highly dependent on the accuracy of electrodes' positioning in the correct anatomical target. During DBS procedure, the opening of the dura mater induces the displacement of neural structures. This effect mainly depends on the loss of the physiological negative intracranial pressure, air inflow, and loss of cerebrospinal fluid. Several studies concentrated on correcting surgical techniques for DBS electrodes' positioning in order to reduce pneumocephalus which may result in therapeutic failure. The authors focused in particular on reducing the brain air window and maintaining the pressure gradient between intra- and extracranial compartments. A significant reduction of pneumocephalus and brain shift was obtained by excluding the opening of the subarachnoid space, by covering the dura mater opening with tissue sealant and by reducing the intracranial pressure in general anesthesia. Smaller burr hole diameters were not statistically relevant for reducing air inflow and displacement of anatomical targets. The review of the literature showed that conserving a physiological intra-extracranial pressure gradient plays a fundamental role in avoiding pneumocephalus and consequent displacement of brain structures, which improves surgical accuracy and DBS long-term results.
Topics: Deep Brain Stimulation; Humans; Parkinson Disease; Pneumocephalus; Plastic Surgery Procedures; Trephining
PubMed: 31897886
DOI: 10.1007/s10143-019-01220-2 -
Radiology Case Reports Apr 2023Pneumocephalus is defined as air in the intracranial space. It is commonly caused by traumatic skull fractures and is diagnosed by head plain computer tomography....
Pneumocephalus is defined as air in the intracranial space. It is commonly caused by traumatic skull fractures and is diagnosed by head plain computer tomography. Treatment involves initial stabilization of vital signs and surgical intervention if symptoms do not resolve. We report a unique case of pneumocephalus following sneeze suppression.
PubMed: 36815145
DOI: 10.1016/j.radcr.2023.01.057