-
International Journal of Infectious... Feb 2022
Topics: Clostridium Infections; Clostridium perfringens; Humans; Pneumocephalus; Pneumorrhachis; Tomography, X-Ray Computed
PubMed: 34883236
DOI: 10.1016/j.ijid.2021.12.311 -
BMC Surgery Jun 2022Pneumocephalus may be responsible for post-craniotomy headache but is easily overlooked in the clinical situation. In the present study, the relationship between the... (Observational Study)
Observational Study
BACKGROUND
Pneumocephalus may be responsible for post-craniotomy headache but is easily overlooked in the clinical situation. In the present study, the relationship between the amount of intracranial air and post-craniotomy headache was investigated.
METHODS
A retrospective observational study was performed on 79 patients who underwent minimal invasive craniotomy for unruptured cerebral aneurysms. Those who had undergone previous neurosurgery, neurological deficit before and after surgery were excluded The amount of air in the cranial cavity was measured using brain computed tomography (CT) taken within 6 h after surgery. To measure the degree of pain due to intracranial air, daily and total analgesic administration amount were used as a pain index. Correlation between intracranial air volume and total consumption of analgesic during hospitalization was tested using Spearman rank correlation coefficients. Receiver operating characteristics (ROC) analysis was used to determine the amount of air associated with increased analgesic consumption over 72 h postoperatively.
RESULTS
The mean amount of intracranial air was 15.6 ± 9.1 mL. Total administration of parenteral and oral analgesics frequency were 6.5 ± 4.5, 13.2 ± 7.9 respectively. A statically significant correlation was observed between daily and total parenteral analgesic consumption after surgery and the amount of intracranial air at followed-up brain CT postoperatively within 24 h (r = 0.69, p < 0.001), within 48 h (r = 0.68, p < 0.001), and total duration after surgery (r = 0.84, p < 0.001). The optimal cut-off value of 12.14 mL of intracranial air predicts the use of parenteral analgesics over 72 h after surgery.
CONCLUSIONS
Pneumocephalus may be a causative factor for post-craniotomy pain and headache with surgical injuries.
Topics: Analgesics; Craniotomy; Headache; Humans; Pain; Pneumocephalus; Postoperative Complications; Postoperative Period
PubMed: 35768812
DOI: 10.1186/s12893-022-01701-0 -
Clinical Practice and Cases in... Feb 2022We describe a delayed case of tension pneumocephalus in a newly altered patient 21 days status-post auto-vs-pedestrian accident. After her initial hospital course, the...
CASE PRESENTATION
We describe a delayed case of tension pneumocephalus in a newly altered patient 21 days status-post auto-vs-pedestrian accident. After her initial hospital course, the patient was discharged to an acute rehabilitation facility in stable condition with Glasgow Coma Scale 15. The patient returned to the emergency department for an acute change in mental status.
DISCUSSION
Tension pneumocephalus is a neurosurgical and otolaryngological emergency.
PubMed: 35226857
DOI: 10.5811/cpcem.2021.9.53603 -
Turkish Neurosurgery 2022To examine the postoperative outcomes of electrode fixation using bone cement and Stimloc® in patients with Parkinson?s disease (PD) who underwent subthalamic nucleus...
AIM
To examine the postoperative outcomes of electrode fixation using bone cement and Stimloc® in patients with Parkinson?s disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS).
MATERIAL AND METHODS
Between 2016 and 2018, permanent electrode fixation was performed in 30 patients with PD, of which 15 received bone cement and the remaining 15 received Stimloc®. Data regarding preoperative Unified Parkinson?s Disease Rating Scale (UPDRS) III scores, levodopa equivalent daily dose (LEDD) values, surgery duration, and the fixation technique used were recorded. Brain computed tomography was performed for early postoperative evaluation of pneumocephalus and possible hematoma as well as for the determination of migration 1 year postoperatively. UPDRS III scores and LEDD values were re-evaluated 1 year postoperatively; surgery duration, clinical effectiveness, and complication rates were compared between the two fixation techniques.
RESULTS
A statistically significant difference in application time was observed between the two techniques (bone cement: 21 min, Stimloc®: 6 min). After 1 year from surgery, 0.92- and 0.88-mm migrations were observed in the bone cement and Stimloc® groups, respectively. A significant correlation between migration and the pneumocephalus volume was observed in both groups. No differences were observed between the groups regarding infection, migration, pneumocephalus volume, wound erosion, and clinical outcomes.
CONCLUSION
Stimloc® is preferred over bone cement for electrode fixation in DBS surgeries as it is associated with shorter application duration; this increases patient comfort and tolerance during awake surgery. Clinical efficacy and complication rates associated with both techniques are similar.
Topics: Bone Cements; Brain Neoplasms; Deep Brain Stimulation; Electrodes; Humans; Levodopa; Parkinson Disease; Pneumocephalus; Treatment Outcome; Wakefulness
PubMed: 35147967
DOI: 10.5137/1019-5149.JTN.35635-21.2 -
American Journal of Respiratory and... Jan 2023
Topics: Humans; Noninvasive Ventilation; Pneumocephalus; Respiration, Artificial; Tomography, X-Ray Computed
PubMed: 36095144
DOI: 10.1164/rccm.202204-0757IM -
Encephalitis (Seoul, Korea) Oct 2023Pneumocephalus refers to a pathologic collection of gas within the cranial cavity and is mostly caused by head trauma and neurosurgical procedures. Spontaneous...
Pneumocephalus refers to a pathologic collection of gas within the cranial cavity and is mostly caused by head trauma and neurosurgical procedures. Spontaneous nontraumatic pneumocephalus is a very rare condition. We herein report an unusual case of community-acquired bacterial meningitis with a combination of acute otitis media, Enterobacter cloacae, and nontraumatic pneumocephalus. A 75-year-old woman presented with fever, mental change, and neck stiffness. Brain imaging demonstrated pneumocephalus and fluid collection in the left mastoid air cells. E. cloacae was isolated from both blood and otorrhea cultures, and the patient was successfully treated with intravenous ceftazidime for 3 weeks. Although E. cloacae is a very rare cause of community-acquired bacterial meningitis in adults, it should be considered as a possible pathogen in otogenic meningitis complicated with pneumocephalus.
PubMed: 37743053
DOI: 10.47936/encephalitis.2023.00164 -
European Annals of Otorhinolaryngology,... Mar 2020
Topics: Female; Headache; Humans; Middle Aged; Nasal Obstruction; Nasal Septum; Pneumocephalus; Postoperative Complications
PubMed: 31862429
DOI: 10.1016/j.anorl.2019.12.011 -
Clinical Neurology and Neurosurgery Mar 2018Pneumocephalus is a common operative complication of chronic subdural hematoma. This study is to analyze the relationship between postoperative pneumocephalus and the... (Observational Study)
Observational Study
OBJECTIVES
Pneumocephalus is a common operative complication of chronic subdural hematoma. This study is to analyze the relationship between postoperative pneumocephalus and the recurrence and surgical outcomes.
PATIENTS AND METHODS
This is a retrospective case-cohort study, including a pneumocephalus group (n = 46) and a control group (n = 181). Their recurrence rates, CT attenuation values, hospital stay, healing time and the neurological status were recorded and analyzed.
RESULTS
The pneumocephalus group had a recurrence rate of 32.6%, significantly higher than the control (17.7%). In addition, the pneumocephalus group had a higher rate of postoperative epilepsy (21.7% vs 3.3%), longer hospital stay (11.5 ± 2.8 vs 7.8 ± 1.2 days), longer healing time (10.8 ± 5.4 vs 6.5 ± 2.3 months), and worse neurological scores than the control.
CONCLUSION
Pneumocephalus increases the recurrence rate of chronic subdural hematoma, and it not only prolongs the hospital stay and healing time, but also leads to deterioration of the neurological status.
Topics: Aged; Aged, 80 and over; Cohort Studies; Female; Follow-Up Studies; Hematoma, Subdural, Chronic; Humans; Length of Stay; Male; Middle Aged; Pneumocephalus; Postoperative Complications; Recurrence; Retrospective Studies
PubMed: 29408774
DOI: 10.1016/j.clineuro.2018.01.029 -
Scientific Reports Jun 2023Although only recently directional leads have proven their potential to compensate for sub-optimally placed electrodes, optimal lead positioning remains the most...
Although only recently directional leads have proven their potential to compensate for sub-optimally placed electrodes, optimal lead positioning remains the most critical factor in determining Deep Brain Stimulation (DBS) outcome. Pneumocephalus is a recognized source of error, but the factors that contribute to its formation are still a matter of debate. Among these, operative time is one of the most controversial. Because cases of DBS performed with Microelectrode Recordings (MER) are affected by an increase in surgical length, it is useful to analyze whether MER places patients at risk for increased intracranial air entry. Data of 94 patients from two different institutes who underwent DBS for different neurologic and psychiatric conditions were analyzed for the presence of postoperative pneumocephalus. Operative time and use of MER, as well as other potential risk factors for pneumocephalus (age, awake vs. asleep surgery, number of MER passages, burr hole size, target and unilateral vs. bilateral implants) were examined. Mann-Whitney U and Kruskal-Wallis tests were utilized to compare intracranial air distributions across groups of categorical variables. Partial correlations were used to assess the association between time and volume. A generalized linear model was created to predict the effects of time and MER on the volume of intracranial air, controlling for other potential risk factors identified: age, number of MER passages, awake vs. asleep surgery, burr hole size, target, unilateral vs. bilateral surgery. Significantly different distributions of air volume were noted between different targets, unilateral vs. bilateral implants, and number of MER trajectories. Patients undergoing DBS with MER did not present a significant increase in pneumocephalus compared to patients operated without (p = 0.067). No significant correlation was found between pneumocephalus and time. Using multivariate analysis, unilateral implants exhibited lower volumes of pneumocephalus (p = 0.002). Two specific targets exhibited significantly different volumes of pneumocephalus: the bed nucleus of the stria terminalis with lower volumes (p < 0.001) and the posterior hypothalamus with higher volumes (p = 0.011). MER, time, and other parameters analyzed failed to reach statistical significance. Operative time and use of intraoperative MER are not significant predictors of pneumocephalus during DBS. Air entry is greater for bilateral surgeries and may be also influenced by the specific stimulated target.
Topics: Humans; Deep Brain Stimulation; Microelectrodes; Pneumocephalus; Operative Time; Trephining
PubMed: 37291256
DOI: 10.1038/s41598-023-30289-5 -
Clinical Neurology and Neurosurgery Feb 2023Compound or open depressed fractures (CDF) is one of the urgent operations of neurosurgery, as it can result in complications of infection. This study is reported to...
BACKGROUND/AIM
Compound or open depressed fractures (CDF) is one of the urgent operations of neurosurgery, as it can result in complications of infection. This study is reported to investigate the effect of topical vancomycin powder to the infection rates in the compound depressed skull fractures which have been operated on.
MATERIALS AND METHODS
This present study was conducted on 46 cases with compound depressed skull fractures which have been operated on. Cases were divided into two groups according to the use of subgaleal topical vancomycin powder during the operation. The preoperative and postoperative CRP levels, localization of the fracture, hospitalization time, operation length, dural injury, pneumocephalus, and mortality rates have been examined.
RESULTS
In cases with dural injury and pneumocephalus, a statistically significant relationship was found between the use of topical vancomycin powder and the frequency of post-op infection (p < 0.001). It was observed that the incidence of postoperative infection was significantly higher in 12 (85.7%) cases with pneumocephalus and dural injury when vancomycin powder was not used. Also, it was observed that the post-operative infection level was significantly higher in fractures in the frontal and parietal regions without vancomycin powder(p < 0.05).
CONCLUSIONS
The use of subgaleal topical vancomycin powder is an option to reduce the infection rates and mortality, especially in the cases of compound depressed fractures, which is considered as a dirty wound and prone to infection. It is especially recommended in the presence of dural injury and pneumocephalus.
Topics: Humans; Skull Fracture, Depressed; Vancomycin; Powders; Pneumocephalus; Neurosurgical Procedures; Surgical Wound Infection; Postoperative Complications; Skull Fractures; Anti-Bacterial Agents; Retrospective Studies
PubMed: 36587442
DOI: 10.1016/j.clineuro.2022.107570