-
Cureus Sep 2021Pneumocephalus is defined as the presence of air in the intracranial cavity, and this complication is rare after ventriculoperitoneal shunt (VPS) surgery. It can be...
Pneumocephalus is defined as the presence of air in the intracranial cavity, and this complication is rare after ventriculoperitoneal shunt (VPS) surgery. It can be caused by traumatic brain injury (TBI), surgical interventions, and anatomical or spontaneous malformation. We present a case of intraventricular pneumocephalus associated with the placement of a VPS. The patient was a 40-year-old man who had a VPS inserted 10-years ago due to hydrocephalus caused by TBI. He presented to the emergency room with complaints of headache, vomiting, rhinoliquorrhea, and fever. Computed tomography of the skull showed ventricular dilatation with intraventricular pneumocephalus. In a three-dimensional reconstruction, a bone defect was visualized with meningocele at the base of the skull that would explain the cerebrospinal fluid fistula. The meningocele was surgically corrected. After 14 days of antibiotic treatment, a new VPS was placed and the patient progressed satisfactorily. Pneumocephalus associated with VPS is a rare condition that can develop secondary to a combination of the shunt effect and an anatomical defect at the base of the skull. Excessively negative and persistent intracranial pressure of the shunt allows air to enter and fill the existing vacuum through the defect in the skull base. This bone defect may be congenital, due to traumatic brain injury, or a result of hydrocephalus itself. Computed tomography of the skull is an excellent investigation for the visualization of bone defects, and treatment involves a correction of the fistula. Pneumocephalus associated with VPS is rare. The presence of rhinoliquorrhea is a strong indication of the condition. Once the presence of a fistula is confirmed, it should be corrected to prevent worsening of the pneumocephalus.
PubMed: 34725626
DOI: 10.7759/cureus.18392 -
Agri : Agri (Algoloji) Dernegi'nin... Jul 2017Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid...
Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.
Topics: Adult; Diagnosis, Differential; Failed Back Surgery Syndrome; Female; Headache; Humans; Ozone; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 29039154
DOI: 10.5505/agri.2016.36024 -
Turkish Neurosurgery 2016Tension pneumocephalus is an uncommon and life-threatening neurological condition. It requires emergent and immediate attention to prevent fatal complications. Head... (Review)
Review
Tension pneumocephalus is an uncommon and life-threatening neurological condition. It requires emergent and immediate attention to prevent fatal complications. Head injury is the most common cause of tension pneumocephalus. Air can gain access into the cranium either through a fracture involving paranasal sinus or the middle ear cavity or even more rarely in association with a compound depressed fracture of the skull vault. Its management includes simple twist drill and aspiration of intracranial air with or without placement of an under water seal. 100% oxygen should be administered by a non-breatheable mask which hastens the resorption of air. The authors report a series of 4 cases of post-traumatic tension pneumocephalus, highlighting its management, and review the pertinent literature.
Topics: Adult; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Pneumocephalus; Skull Fractures
PubMed: 26956830
DOI: 10.5137/1019-5149.JTN.4238-11.1 -
Cureus Aug 2023Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection....
Pneumocephalus, or air entrapment within the cranium, is a rare but dangerous condition with a variety of causes, including trauma, surgery, or predisposing infection. Trauma is the most common etiology, as fractures provide easy access for air to become entrapped in the cranium. However, access such as via the central nervous system with leak exists. Though not as common as traumatic pneumocephalus, pneumocephalus secondary to infection is a dangerous condition. The literature is sparse on this example of ear-nose-throat infection, making it difficult to form and ascertain guidelines for the management of infectious pneumocephalus and its complications. A 58-year-old man with a history of hypertension, obesity, type 2 diabetes mellitus, and obstructive sleep apnea who presented with a complicated case of acute otitis media associated with subdural empyema, pneumocephalus, and group A Streptococcus is presented in this case report. We describe the course of his hospital stay, management, and current infectious disease guidelines. Given the paucity of cases of infectious pneumocephalus secondary to otitis media, we aim to provide further representation for this important illness as well as encourage the use of a multimodal team of providers. In our case, it was necessary to involve the ear-nose-throat specialist as well as infectious disease and neurocritical care services.
PubMed: 37727174
DOI: 10.7759/cureus.43756 -
Iranian Journal of Otorhinolaryngology May 2018Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously...
INTRODUCTION
Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.
CASE REPORT
A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.
CONCLUSION
Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus
PubMed: 29876334
DOI: No ID Found -
Frontiers in Neuroscience 2022The accuracy of the deep brain stimulation (DBS) electrode placement is influenced by a myriad of factors, among which pneumocephalus and loss of cerebrospinal fluid...
BACKGROUND
The accuracy of the deep brain stimulation (DBS) electrode placement is influenced by a myriad of factors, among which pneumocephalus and loss of cerebrospinal fluid that occurs with dural opening during the surgery are considered most important. This study aimed to describe an effective method for decreasing pneumocephalus by comparing its clinical efficacy between the two different methods of opening the dura.
MATERIALS AND METHODS
We retrospectively compared two different methods of opening the dura in 108 patients who underwent bilateral DBS surgery in our center. The dural incision group comprised 125 hemispheres (58 bilateral and 9 unilateral) and the dural puncture group comprised 91 (41 bilateral and 9 unilateral). The volume of intracranial air, dural opening time, intraoperative microelectrode recordings (MERs), postoperative electrode displacement, clinical efficacy, and complications were examined. Spearman correlation analysis was employed to identify factors associated with the volume of intracranial air and postoperative electrode displacement.
RESULTS
The volume of intracranial air was significantly lower (0.35 cm vs. 5.90 cm) and dural opening time was significantly shorter (11s vs. 35s) in the dural puncture group. The volume of intracranial air positively correlated with dural opening time. During surgery, the sensorimotor area was longer (2.47 ± 1.36 mm vs. 1.92 ± 1.42 mm) and MERs were more stable (81.82% vs. 47.73%) in the dural puncture group. Length of the sensorimotor area correlated negatively with the volume of intracranial air. As intracranial air was absorbed after surgery, significant anterior, lateral, and ventral electrode displacement occurred; the differences between the two groups were significant (total electrode displacement, 1.0mm vs. 1.4mm). Electrode displacement correlated positively with the volume of intracranial air. Clinical efficacy was better in the dural puncture group than the dural incision group (52.37% ± 16.18% vs. 43.93% ± 24.50%), although the difference was not significant.
CONCLUSION
Our data support the hypothesis that opening the dura via puncture rather than incision when performing DBS surgery reduces pneumocephalus, shortens dural opening time, enables longer sensorimotor area and more stable MERs, minimizes postoperative electrode displacement, and may permit a better clinical efficacy.
PubMed: 36408391
DOI: 10.3389/fnins.2022.988661 -
Journal of the Chinese Medical... Feb 2016Post-traumatic cerebrospinal fluid (CSF) leakage is one of the most troublesome conditions associated with head trauma. CSF fistulae, meningitis/central nervous...
BACKGROUND
Post-traumatic cerebrospinal fluid (CSF) leakage is one of the most troublesome conditions associated with head trauma. CSF fistulae, meningitis/central nervous infection, or even death may accompany it. Few studies have discussed post-traumatic CSF leakage as a risk factor in mortality following head trauma. We conducted this cohort study to examine the issue.
METHODS
We reviewed the records in the Taiwan Traumatic Brain Injury (TBI) Registry System between 1993 and 2008. The study group included patients with acute TBI and post-traumatic CSF leakage, and the control group included cases with TBI but without CSF leakage, selected randomly at a 5:1 ratio with respect to the study group. The demographic data, Glasgow Coma Scale, brain computerized tomography, association of skull fractures and intracranial lesions, and 1-year mortality rates between these two cohorts were reviewed meticulously and analyzed statistically.
RESULTS
Of 174,236 cases, 1773 with post-traumatic CSF leakage were included in the study group, and 8865 cases in the control group. Of the total 10,638 sampled cases, 406 (3.8%) died during the 1-year follow-up period, 159 (9.0%) cases in the CSF leakages group, and 247 (2.8%) in the control group. The patients with CSF leakage had a significantly higher mortality rate within 1 year (adjusted hazard ratio = 1.44, p < 0.001) than those without. We divided the CSF leakage group into three subgroups: otorrhea (n = 568), rhinorrhea (n = 302), and tension pneumocephalus (n = 903). The mortality rates were 8.5% (48/568) in the otorrhea subgroup, 10.9% (33/302) in the rhinorrhea subgroup, and 8.6% (78/903) in the tension pneumocephalus subgroup. The cases with CSF rhinorrhea had a significantly higher mortality rate than the other two subgroups (p < 0.05). All three subgroups had significantly higher mortality rates than the control group during the 1-year follow-up period (adjusted hazard ratios = 2.29, 1.35, and 1.32 in the rhinorrhea, tension pneumocephalus, and otorrhea subgroups, respectively).
CONCLUSION
Post-traumatic CSF leakages had higher mortality rates than those without CSF leakages in TBI cases, and the cases with CSF rhinorrhea had worse outcomes compared with CSF leakages with pneumocephalus or otorrhea.
Topics: Adolescent; Adult; Aged; Brain Injuries, Traumatic; Cerebrospinal Fluid Leak; Cranial Nerve Injuries; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk; Skull Fractures; Trauma Severity Indices
PubMed: 26617240
DOI: 10.1016/j.jcma.2015.10.002 -
The Journal of International Advanced... Dec 2020Pneumocephalus after cochlear implantation is very rare with five reported cases in the literature. The presence of clinical features in the immediate postoperative... (Review)
Review
Pneumocephalus after cochlear implantation is very rare with five reported cases in the literature. The presence of clinical features in the immediate postoperative period has never been reported, because they occur weeks after surgery. These neurological manifestations can compromise the patient's life; thus, it is important to have proper knowledge and management of these manifestations. We present a case report with a review of the literature. A 35-year-old man began having seizures a few hours after a cochlear implantation. Computed tomography (CT) scan revealed a pneumocephalus and bone defect at the level of the electrode's drilling path, not objected during the surgery. The patient was handled conservatively, and in subsequent reviews, CT objected reabsorption of the pneumocephalus. The presence of a pneumocephalus should be taken into account in the neurological features of a patient with cochlear implant, especially if mastoid bone defects are suspected during surgery. The management of the pneumocephalus will, in most cases, be conservative, consisting of clinical observation and imaging tests. Surgical treatment is reserved for situations in which the clinical manifestations are very symptomatic and when they are tension pneumocephalus.
Topics: Adult; Cochlear Implantation; Cochlear Implants; Humans; Male; Pneumocephalus; Postoperative Complications; Seizures
PubMed: 33136031
DOI: 10.5152/iao.2020.7601 -
Archives of Clinical and Medical Case... 2022There has been a recognizable surge in cosmetic surgery in recent years, partly influenced by social media, and the easy accessibility to such medical procedures. As...
There has been a recognizable surge in cosmetic surgery in recent years, partly influenced by social media, and the easy accessibility to such medical procedures. As with all types of surgery, the risks of complications are real, and in this specific setting, they tend to occur in a younger age group. Here, we discuss a rare complication and subsequent presentation of tension pneumocephalus, following an episode of cardiac arrest in a 58 year old female, during elective cosmetic-facial surgery. Typically, pneumocephalus develops when there are skull or facial bone fractures, and presents characteristically with leakage of cerebrospinal fluid from the ears and/or nose. The absence of the typical clinical signs and the lack of a clinical history or radiologically evidence of skull or facial bone fractions, may result in a delayed diagnosis, permanent brain injury and death. Awareness of such an unusual complication is therefore crucial when considering any surgery to the head and face (including cosmetic surgery), or following prolonged resuscitative efforts, which may well develop days after the inciting event.
PubMed: 36686216
DOI: 10.26502/acmcr.96550553 -
Surgical Neurology International 2022Chronic subdural hematoma (CSDH) commonly affects older individuals and is associated with a relatively high rate of recurrence after surgery. Many studies have created...
BACKGROUND
Chronic subdural hematoma (CSDH) commonly affects older individuals and is associated with a relatively high rate of recurrence after surgery. Many studies have created grading systems to identify patients at high risk of CSDH recurrence after the initial surgery. However, no system has been adopted widely. The authors present the first CSDH grading system created from a population-based single-center data set.
METHODS
A single-center Puerto Rican population-based retrospective analysis was performed on consecutive patients treated for a CSDH at a designated institution from July 1, 2017 to December 31, 2019. Univariate and multivariate analyses were used to create a CSDH recurrence grading scale. Retrospective validation was conducted on this sample population.
RESULTS
The study included 428 patients. Preoperative midline shift, postoperative midline shift, and size of postoperative subdural space differed between the recurrence and nonrecurrence groups ( = 0.03, 0.002, and 0.002, respectively). A multivariate analysis was used to create a 10-point grading scale comprising four independent variables. Recurrence rates progressively increased from the low-risk (0-3 points) to high-risk (8-10 points) groups (2.9% vs. 20.3%; < 0.001).
CONCLUSION
A 10-point grading scale for CSDH recurrence was developed with four components: preoperative midline shift (≤1 and >1 cm), laterality (bilateral, unilateral-right, and unilateral-left), size of postoperative subdural space (≤1.6 and >1.6 cm), and pneumocephalus (present or absent). Patients who scored higher on the scale had a higher risk of recurrence. This CSDH grading scale has implications for Puerto Rico and the general population as the elderly population increases worldwide.
PubMed: 35855136
DOI: 10.25259/SNI_240_2022