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World Neurosurgery Nov 2022Traumatic subarachnoid-pleural fistula is an uncommon occurrence. We present a case of a patient sustaining a subarachnoid-pleural fistula after a gunshot wound to the...
Traumatic subarachnoid-pleural fistula is an uncommon occurrence. We present a case of a patient sustaining a subarachnoid-pleural fistula after a gunshot wound to the neck, which ultimately resulted in substantial pneumocephalus. The patient underwent successful operative repair of the fistula with notable improvement and resolution of pneumocephalus.
Topics: Humans; Pneumocephalus; Wounds, Gunshot; Pleural Diseases; Pleura; Subarachnoid Space; Fistula
PubMed: 35917920
DOI: 10.1016/j.wneu.2022.07.080 -
Pediatric Emergency Care Nov 2023Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head...
OBJECTIVES
Mild traumatic brain injury (mTBI) comprises most (70%-90%) of all pediatric head trauma cases seeking emergency care. Although most mTBI cases have normal initial head computed tomography scan, a considerable portion of the cases have intracranial imaging abnormalities on computed tomography scan. Whereas other intracranial pathological findings have been extensively studied, little is known about the clinical significance of pneumocephalus in pediatric mTBI.
METHODS
We retrospectively identified pediatric mTBI patients with pneumocephalus using the institutional database of a large regional trauma referral center. Outcome measures were defined as clinically important TBI (ciTBI), hospitalization, intensive care unit (ICU) admission, and neurosurgical intervention. Comparisons were made between pneumocephalus and control (isolated linear fracture) groups as well as between isolated (only linear fracture and pneumocephalus) and nonisolated pneumocephalus (pneumocephalus and TBI) groups.
RESULTS
Among 3524 pediatric mTBI cases, 43 cases had pneumocephalus (1.2%). Twenty-one cases (48.8%) had isolated pneumocephalus. The pneumocephalus group had higher rates of ciTBI, hospital admission, ICU admission, and neurosurgery when compared with the isolated linear fracture (control) group. The isolated pneumocephalus group had fewer ciTBI (21.1% vs 70%, P = 0.002), fewer hospitalization (23.8% vs 81.8%, P < 0.001), but similar ICU admission rates (4.8% vs 22.7%, P = 0.089) and length of hospital stay (4.0 ± 2.7 vs 3.6 ± 2.4 days, P = 0.798) in comparison to the nonisolated pneumocephalus group. None of the patients in the isolated group had neurosurgery whereas 2 patients in the nonisolated pneumocephalus group underwent surgery. Multivariable analysis revealed pneumocephalus as an independent predictor of ciTBI and hospital admission, but not ICU admission or neurosurgical intervention.
CONCLUSION
Pneumocephalus is associated with increased rates of hospitalization and ciTBI, but not ICU admission, unfavorable outcome, or neurosurgical intervention in pediatric mTBI. Although usually spontaneously resolving pathology, it may occasionally be linked with complications such as cerebrospinal fluid leakage, meningitis, and tension pneumocephalus. Therefore, careful evaluation, close observation, and early detection of complications may prevent adverse outcomes.
Topics: Child; Humans; Brain Concussion; Pneumocephalus; Retrospective Studies; Clinical Relevance; Brain Injuries, Traumatic; Fractures, Bone
PubMed: 37815282
DOI: 10.1097/PEC.0000000000003060 -
The International Journal of... Jul 2020Intracerebral pneumocephalus is commonly associated with head and facial trauma, ear infection, tumors and surgical interventions. Osteomas are relatively common, benign...
Intracerebral pneumocephalus is commonly associated with head and facial trauma, ear infection, tumors and surgical interventions. Osteomas are relatively common, benign tumors that occur mainly in the paranasal sinuses, the frontal sinus in particular. Pneumocephalus has been commonly reported with frontal osteoma but isolated presentation as frontotemporal dementia is uncommon. Patient was admitted with complaints of change of behavior and forgetfulness for the last one year. He had progressively become more apathetic and presented with behavioral abnormalities. General physical examinations were within normal limits including the motor and sensory system although neuropsychiatry assessments were below the average level, with features of dementia. Further, MRI brain revealed pneumocephalus in bilateral frontal lobe. CT cisternography revealed a well defined lobulated densely sclerotic lesion of approximate size 20 × 17 × 27mm transverse and cranio-caudal axis respectively arising from right ethmoid sinus. Clinically, the association of pneumocephalus and isolated presentation as frontotemporal dementia has not been described to the best of our knowledge. A single case has been described with ethmoid osteoma. Radiological features were suggestive of osteoid osteoma. The uniqueness of the case is the development of dementia with frontotemporal involvement and resemblance with Frontotemporal Dementia. This is the only case with dementia and pneumocephalus (secondary to osteoid osteoma) to best of our knowledge.
Topics: Bone Neoplasms; Ethmoid Sinus; Frontotemporal Dementia; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteoma; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 31814503
DOI: 10.1080/00207454.2019.1702538 -
Acta Neurochirurgica Jul 2021Chronic subdural hematoma (CSDH) is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade....
BACKGROUND
Chronic subdural hematoma (CSDH) is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade. Considering various features of CSDH and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional comfort for both the patient and the surgeon. The aim of this study was to describe the technical aspects of this procedure in the sitting position, to evaluate safety and discuss the benefits and shortcomings of this modification.
METHOD
This study included a series of 55 patients surgically treated for CSDH in a sitting position at our department between December 2017 and September 2019, representing all the patients operated on during the study period by a single surgeon. Bilateral hematomas were present in 19 patients. Outcomes, during the 6-month follow-up period, were defined as good (CSDH and symptoms resolved) or poor (lethal outcome or reoccurrence). All complications were noted, with emphasis on pneumocephalus, and complications related to the sitting position: tension pneumocephalus, venous air embolism, and compression nerve injury.
RESULTS
Complications previously associated with the sitting position were not noted. The Glasgow Coma Scale and Markwalder Grading Scale scores improved significantly after the surgery (p < 0.001 and p = 0.018). Complications were noted in 17 patients (30.9%), and included 5 cerebrospinal fluid drainages, 3 hematoma reoccurrences, 2 wound infections, and 9 more single-occurring complications. The in-hospital mortality was 5.4% (3 out of 55 patients), while the overall mortality was 16.4% within the 6-month follow-up period.
CONCLUSIONS
In our series, even the severely ill patients tolerated the position well. No complications associated with the sitting position were noted. Future studies should confirm the safety of this position and evaluate the potential advantages for both the patient and the surgeon.
Topics: Brain Neoplasms; Hematoma, Subdural, Chronic; Humans; Retrospective Studies; Sitting Position; Wakefulness
PubMed: 33464424
DOI: 10.1007/s00701-021-04704-7 -
World Neurosurgery Oct 2019Durotomy is a necessary procedure for resection of spinal intradural-extramedullary (IDEM) tumor. The purpose of this study was to investigate the prevalence and... (Observational Study)
Observational Study
OBJECTIVE
Durotomy is a necessary procedure for resection of spinal intradural-extramedullary (IDEM) tumor. The purpose of this study was to investigate the prevalence and clinical implications of pneumocephalus after spinal IDEM tumor surgery and also the association between pneumocephalus and postoperative headache.
METHODS
This prospective study was conducted in a cohort of 20 patients who were diagnosed with a spinal IDEM tumor and underwent surgical resection. The mean patient age was 53.6 years (range, 29-75 years). Histological findings revealed schwannoma in 16 cases (80.0%) and meningioma in 4 cases (20.0%). Brain computed tomography scan was performed immediately after surgery. The prevalence and severity were analyzed based on the classification into 4 groups according to the extension of pneumocephalus: absence, mild, moderate, and severe. A visual analog scale (VAS; range 0-10) for headache was reported daily for the first postoperative week. Headache-related pneumocephalus was defined as a VAS score of ≥5 points at least once in that 1-week period.
RESULTS
The prevalence of pneumocephalus was 90.0% (18 patients). Five patients (25.0%) had severe pneumocephalus extending to the extra-axial space. Seven of the 20 patients (38.9%) complained of significant headache. Five of these patients had severe pneumocephalus, 1 patient had moderate pneumocephalus, and 1 patient had moderate pneumocephalus. A statistically significant association was observed between the severity of pneumocephalus and headache (P = 0.001).
CONCLUSIONS
Pneumocephalus is a common complication after spinal IDEM tumor surgery. This report is the first study to investigate the prevalence of pneumocephalus and analyze its association with headache after spine surgery. The severity of pneumocephalus was significantly related to postoperative headache.
Topics: Adult; Aged; Cohort Studies; Female; Humans; Male; Middle Aged; Pneumocephalus; Postoperative Complications; Prospective Studies; Spinal Cord Neoplasms; Treatment Outcome
PubMed: 31229753
DOI: 10.1016/j.wneu.2019.06.085 -
Cureus Aug 2022A cochlear implant is a neuroprosthetic, electrical device that is developed for the treatment of patients who have sensory hearing loss. It directly stimulates the... (Review)
Review
A cochlear implant is a neuroprosthetic, electrical device that is developed for the treatment of patients who have sensory hearing loss. It directly stimulates the hearing nerve by bypassing the injured or damaged sensory receptors, the hair cells. This implant is directly placed in the inner ear. It is an electronic device which is proved to be very useful in patients with sensorineural hearing loss. This implant consists of a speech processor (externally present), which takes up the sound; transforms it into digital signals, and then internal components take it to convert it into electrical energy, which stimulates auditory nerves, and the brain perceives it and hears it as a sound. This is one of the most successful surgeries, which happens very frequently nowadays. Although, many complications are mostly associated with this implant. This paper deals with the preoperative, operative, and postoperative complications associated with cochlear implant surgery. That includes tinnitus, Meniere's disease, unilateral hearing loss, musical ear syndrome, infections; flap necrosis, facial nerve palsy, improper electrode placement, magnet displacement; failure and re-implantation, cholesteatoma, and pneumocephalus. These are just a few of the complications; there are much more complications which are associated with cochlear implants.
PubMed: 36148185
DOI: 10.7759/cureus.28151 -
Brain Sciences Mar 2023Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area...
BACKGROUND
Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA) as the most common targets. The stimulation efficacy of ET with Vim-PSA double-target DBS has been reported. Herein, we aim to propose surgical techniques for Vim-PSA double-target DBS surgery.
METHODS
This study enrolled six patients with ET who underwent Vim-PSA double-target electrode implantation from October 2019 to May 2022. The targets were located and adjusted using coordinates and multimodality MRI images. A burr hole was accurately drilled in line with the electrode trajectory under the guidance of a stereotactic frame. Novel approaches were adopted during the electrode implantation process for pneumocephalus reduction, including "arachnoid piamater welding" and "water sealing". Electrophysiological recording was used to identify the implantation sites of the electrodes. A 3D reconstruction model of electrodes and nuclei was established to facilitate programming.
RESULTS
The combination of coordinates and multimodality MRI images for target location and adjustment enabled the alignment of Vim and PSA. Postoperative CT scanning showed that the electrode was precisely implanted. Stereotactic guidance facilitated accurate burr hole drilling. "Arachnoid piamater welding" and "water sealing" were efficient in reducing pneumocephalus. Intraoperative electrophysiological verified the efficacy of Vim-PSA double-target DBS surgery.
CONCLUSIONS
The methods for target location and adjustment, accurate drilling of the burr hole, reduction in pneumocephalus, and intraoperative electrophysiological verification are key issues in DBS surgery targeting both the Vim and PSA. This study may provide technical support for Vim-PSA DBS, especially for surgeons with less experience in functional neurosurgery.
PubMed: 37190531
DOI: 10.3390/brainsci13040566 -
European Journal of Case Reports in... 2023A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental...
UNLABELLED
A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery.
LEARNING POINTS
Changes in mental status in a patient with a history of chronic hydrocephalus should alert clinicians to a possible complication.This case reflects the delayed diagnosis of a critically ill patient in the emergency department.
PubMed: 38077697
DOI: 10.12890/2023_004160 -
American Journal of Otolaryngology 2020Lumbar drains are frequently used in patients with otolaryngologic concerns. These can be used therapeutically or prophylactically with the primary purpose being to... (Review)
Review
INTRODUCTION
Lumbar drains are frequently used in patients with otolaryngologic concerns. These can be used therapeutically or prophylactically with the primary purpose being to modulate CSF pressure. Within otolaryngology, lumbar drains are most frequently used for cerebrospinal fluid leaks - either due to cerebrospinal fluid fistulas or in skull base surgery as these allow for potential healing of the defect. While not typically placed by otolaryngologists, a basic understanding of lumbar drains is beneficial in the context of patient management.
MANAGEMENT
A lumbar drain is inserted into the intrathecal space in a patient's lumbar spine. Though considered to be a benign procedure, complications are relatively frequent, and adjustment or replacement of the drain may be required. Complications include infection, epidural bleeding, retained hardware, sequelae of relative immobility, or may relate to over-drainage, ranging from mild headache to cranial neuropathies, altered mental status, pneumocephalus, intracranial hemorrhage, and death. While in place, neurologic exams should be performed routinely and should include motor and sensory exams of the lower extremities. A patient should be monitored for fevers, nuchal rigidity, and other signs of infection or meningitis. The CSF fluid should be grossly examined to identify changes, but routine laboratory tests are not typically run on the fluid itself. Drainage rates will vary usually between 5 and 20 mL per hour and must be frequently reassessed and adjusted based upon signs of intracranial hypotension. Drains should be removed when appropriate and should not be left in more than 5 days due to the increased infectious risk.
CONCLUSION
Lumbar drains are important tools used in patients with otolaryngologic pathologies. Otolaryngologists and otolaryngology residents should be familiar with these catheters to determine if they are working correctly and to identify adverse effects as early as possible.
Topics: Cerebrospinal Fluid Leak; Device Removal; Drainage; Humans; Infections; Intracranial Hypotension; Lumbar Vertebrae; Otolaryngologists; Postoperative Complications; Time Factors
PubMed: 32979671
DOI: 10.1016/j.amjoto.2020.102740 -
Ear, Nose, & Throat Journal Sep 2021Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related...
Balloon sinus dilation (BSD) is a common method of relieving sinus outflow obstruction. With the rising utilization of BSD, increasing numbers of BSD-related complications have also been reported. Here, we report a case of pneumocephalus and cerebrospinal fluid leak following BSD of the frontal sinus. Additionally, a review of the literature regarding BSD complications was performed.
Topics: Aged; Dilatation; Frontal Sinus; Humans; Male; Neuroimaging; Paranasal Sinus Diseases; Pneumocephalus; Skull Base; Tomography, X-Ray Computed
PubMed: 34392735
DOI: 10.1177/01455613211037629