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Indian Journal of Otolaryngology and... Apr 2023Tension Pneumocephalus and spontaneous CSF rhinorrhea are very rare associations in clinical practice. We report a case of 65 years old male with clear rhinorrhea,...
Tension Pneumocephalus and spontaneous CSF rhinorrhea are very rare associations in clinical practice. We report a case of 65 years old male with clear rhinorrhea, severe frontal headache, vomiting and lethargy for a week. MR Cisternography and CT Paranasal sinuses showed significant Tension Pneumocephalus with defect in the posterior wall of sphenoid sinus and CSF pooling in the sphenoid sinus. Endoscopic trans-sphenoidal CSF leak repair was done without any delay followed by complete resolution of Tension Pneumocephalus with in 4 post op days. Prompt precise diagnosis and early intervention of Tension Pneumocephalus is vital to avoid neurological complications.
PubMed: 37206754
DOI: 10.1007/s12070-022-03223-w -
Pneumocephalus after surgical evacuation of chronic subdural hematoma: Is it a serious complication?Asian Journal of Neurosurgery Apr 2012Pneumocephalus is commonly encountered after surgical evacuation of chronic subdural hematoma (CSDH). This study was done to study the incidence, clinical presentation,...
BACKGROUND
Pneumocephalus is commonly encountered after surgical evacuation of chronic subdural hematoma (CSDH). This study was done to study the incidence, clinical presentation, and management of patients who developed pneumocephalus after surgical evacuation of CSDH.
MATERIALS AND METHODS
This prospective study was carried out on consecutive 50 patients who had received surgical treatment for CSDH. All the patients included were followed-up postoperatively with regular clinical and computed tomography (CT) examinations immediately postoperatively, before discharge, and 2 months after surgery. Pneumocephalus was classified into simple and tension, based upon the clinical and radiological criteria. The neurologic grading system of Markwalder et al was used to evaluate the surgical results.
RESULTS
The immediate postoperative CT scan showed pneumocephalus in 22 patients (44%). Tension pneumocephalus was found in two patients who did not require any further surgery. There was statistically significant increase in the incidence of pneumocephalus (immediate and postoperative) in the patients aged over 60 years as well as those presenting with a midline shift more than 5 mm in their CT scan. With regard to the 22 cases of pneumocephalus, good postoperative results were found in 16 patients (73%), while bad results were found in 6 patients (27%). No statistically significant difference in the outcome between patients who had pneumocephalus after surgery and those who had not.
CONCLUSION
Pneumocephalus after surgical evacuation of CSDH is a common finding in the immediate CT scan as well as at time of discharge. Tension pneumocephalus may not require surgical intervention and simple aspiration of air using a syringe may be sufficient.
PubMed: 22870154
DOI: 10.4103/1793-5482.98647 -
Journal of Neurosurgery. Case Lessons Apr 2022Intracranial air may become trapped inside the cranial vault after cranial surgery, causing tension pneumocephalus with a variety of possible neurological symptoms. The...
BACKGROUND
Intracranial air may become trapped inside the cranial vault after cranial surgery, causing tension pneumocephalus with a variety of possible neurological symptoms. The authors reported a unique case in which position-dependent tension pneumocephalus developed after standard pituitary adenoma resection, causing severe intermittent visual symptoms.
OBSERVATIONS
A tiny hole in the sellar floor after transsphenoidal surgery created a valve mechanism, allowing pressurized air accumulation inside the tumor capsule that periodically compressed the optic chiasm. This caused acute visual field defects only when the patient was in an upright position. Symptoms resolved when the patient lay down because pressurized air was allowed to escape from the cranial vault and compression of the optic chiasm was relieved. This phenomenon was verified with consecutive magnetic resonance imaging sequences demonstrating the relaxation of suprasellar space, after the intracranial air had escaped in a horizontal imaging position.
LESSONS
Imperfect sealing of the sellar floor after transsphenoidal surgery is not uncommon. Even a tiny defect may in rare cases work in a valve-like manner, leading to intermittent air accumulation in the suprasellar space and causing corresponding visual symptoms. Pressure pneumocephalus inside an empty tumor capsule should be kept in mind as a possible rare complication after transsphenoidal surgery.
PubMed: 36303508
DOI: 10.3171/CASE21678 -
Surgical Neurology International 2018Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus...
BACKGROUND
Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus presents with headache, encephalopathy, or symptoms of elevated intracranial pressure. Here, we present a case of iatrogenic tension pneumocephalus following endoscopic sinus surgery, presenting as abnormal involuntary movements resembling a movement disorder with choreiform movements.
CASE DESCRIPTION
A 67-year-old previously healthy male presented with new onset chorea and dystonia associated with headache, encephalopathy, and postural instability 4 days after undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyps. Computed tomography showed prominent intraventricular pneumocephalus causing enlargement of the anterior horns of both lateral ventricles with lateral displacement of the basal ganglia nuclei and a bony defect in the skull base. Neurosurgical correction of the cranial defect provided complete symptomatic resolution. Pneumocephalus as a result of an iatrogenic injury of the skull base manifesting as an acute movement disorder is a rare complication of a nasal sinus procedure. We speculate that compression of the caudate nucleus and striatum resulted in decreased pallidothalamic inhibition and thalamocortical disinhibition leading to the development of a hyperkinetic movement disorder.
CONCLUSION
This unusual presentation of a common procedure illustrates a neurological emergency that requires prompt recognition and timely correction.
PubMed: 30294497
DOI: 10.4103/sni.sni_190_18 -
Journal of Neurosurgery. Case Lessons Sep 2023Cranial and spinal cerebrospinal fluid (CSF) leaks are associated with opposite CSF fluid dynamics. The differing pathophysiology between spontaneous cranial and spinal...
BACKGROUND
Cranial and spinal cerebrospinal fluid (CSF) leaks are associated with opposite CSF fluid dynamics. The differing pathophysiology between spontaneous cranial and spinal CSF leaks are, therefore, mutually exclusive in theory.
OBSERVATIONS
A 66-year-old female presented with tension pneumocephalus. The patient underwent computed tomography (CT) scanning, which demonstrated left-sided tension pneumocephalus, with an expanding volume of air directly above a bony defect of the tegmen tympani and mastoideum. The patient underwent a left middle fossa craniotomy for repair of the tegmen CSF leak. In the week after discharge, she developed a recurrence of positional headaches and underwent head CT. Further magnetic resonance imaging of the brain and thoracic spine showed bilateral subdural hematomas and multiple meningeal diverticula.
LESSONS
Cranial CSF leaks are caused by intracranial hypertension and are not associated with subdural hematomas. Clinicians should maintain a high index of suspicion for intracranial hypotension due to spinal CSF leak whenever "otogenic" pneumocephalus is found. Close postoperative follow-up and clinical monitoring for symptoms of intracranial hypotension in any patients who undergo repair of a tegmen defect for otogenic pneumocephalus is recommended.
PubMed: 37728168
DOI: 10.3171/CASE23300 -
Ear, Nose, & Throat Journal Jul 2013We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema...
We conducted a retrospective case review at a tertiary academic medical center for the complications of pneumolabyrinth with pneumocephalus and subcutaneous emphysema after surgery for middle ear and cochlear implants. Charts of 76 cochlear implant and 2 middle ear implant patients from January 2001 through June 2009 were reviewed. We identified 1 cochlear implant recipient with pneumolabyrinth and pneumocephalus, and 1 middle ear implant recipient with subcutaneous emphysema. Surgical exploration was performed for the pneumolabyrinth with pneumocephalus; the subcutaneous emphysema was managed conservatively. The patient with the cochlear implant, who had had a ventriculoperitoneal shunt placed, experienced pneumolabyrinth with pneumocephalus 6 years after uneventful surgery. Middle ear exploration revealed no residual fibrous tissue seal at the cochleostomy. The middle ear and cochleostomy were obliterated with muscle, fat, and fibrin glue. The ventriculoperitoneal shunt was deactivated, with clinical and radiographic resolution. On postoperative day 5, the patient who had undergone the middle ear implant reported crepitance over the mastoid and implant device site after repeated Valsalva maneuvers. Computed tomography showed air surrounding the internal processor. A mastoid pressure dressing was applied and the subcutaneous emphysema resolved. These 2 cases support the importance of recognizing the clinical presentation of pneumolabyrinth with associated pneumocephalus, as well as subcutaneous emphysema. Securing the internal processor, adequately sealing the cochleostomy, and providing preoperative counseling regarding Valsalva maneuvers and the potential risk of cochlear implantation in the presence of a ventriculoperitoneal shunt may prevent adverse sequelae.
Topics: Adult; Cochlear Implantation; Emphysema; Female; Humans; Labyrinth Diseases; Male; Middle Aged; Ossicular Replacement; Pneumocephalus; Retrospective Studies; Subcutaneous Emphysema
PubMed: 23904304
DOI: 10.1177/014556131309200707 -
Cureus Dec 2023A subdural hematoma (SDH) is a medical condition caused by a violent head trauma in which blood accumulates excessively under the dura mater. It occurs when a blood...
Early Mobilization and Rehabilitation to Enhance the Functional Performance of a Hemiparesis Patient Following a Subdural and Subarachnoid Hematoma With Pneumocephalus: A Case Report.
A subdural hematoma (SDH) is a medical condition caused by a violent head trauma in which blood accumulates excessively under the dura mater. It occurs when a blood arterial weak point or brain surface aneurysm ruptures and bleeds. The resulting blood accumulation inside and around the skull raises the pressure on the brain. Pneumocephalus, also known as pneumatocele or intracranial aerogel, refers to air in the ventricular cavities or brain parenchyma's epidural, subdural, or subarachnoid spaces. In most cases, neurotrauma is the primary cause of pneumocephalus, mainly when there are skull base fractures. Here, we present a case study of a 65-year-old male patient diagnosed with left hemiplegia following SDH with subarachnoid hematoma (SAH) and pneumocephalus. The severity of the patient's illness, the medical and surgical care provided, the amount of physiotherapy required to aid recovery, the duration of hospitalization, and the discharge location for patients with acute SAH or SDH vary significantly. The patient underwent physiotherapy rehabilitation, and we report that his lower limb strength improved substantially after the therapy. Therefore, physiotherapy is a critical component of treatment to enhance muscle strength, facilitate early and rapid recovery, and manage the clinical manifestations of the condition.
PubMed: 38288164
DOI: 10.7759/cureus.51199 -
Surgical Neurology International 2021Tension pneumocephalus is a rare complication after intracranial procedures and craniotomy. We report a rare case of intraventricular and subdural tension pneumocephalus...
BACKGROUND
Tension pneumocephalus is a rare complication after intracranial procedures and craniotomy. We report a rare case of intraventricular and subdural tension pneumocephalus occurring 2 months after repeat right-sided microvascular decompression (MVD) for recurrent trigeminal neuralgia.
CASE DESCRIPTION
The patient in this case was a 79-year-old woman who presented with acute-onset confusion, headaches, nausea, and vomiting. On computed tomography, substantial volumes of pneumocephalus in the fourth ventricle and subdural space at the site of the retrosigmoid exposure for the previous MVD were seen. She underwent emergent wound exploration, and no obvious dural defect or exposed mastoid air cells were identified. The dura was reopened, and the surgical site was copiously irrigated. Mastoid air cells were covered with ample amounts of bone wax, and the wound was closed. The patient recovered well postoperatively with complete resolution of the pneumocephalus by her 3-month follow-up evaluation.
CONCLUSION
It is important to assess for cerebrospinal fluid leakage and that air cells are sealed off before wound closure to prevent a pathway for air to egress into the surgical cavity and corridor.
PubMed: 34345452
DOI: 10.25259/SNI_917_2020 -
Cureus Apr 2024Pneumocephalus due to a subarachnoid-pleural fistula (SPF) has previously been described in the literature and is a rare complication following thoracic surgery. In this...
Pneumocephalus due to a subarachnoid-pleural fistula (SPF) has previously been described in the literature and is a rare complication following thoracic surgery. In this report, we discuss a patient who developed profound neurologic sequelae following right-sided pneumonectomy which was complicated by T2 nerve root avulsion and SPF development. The patient returned to the OR on postoperative day 21 in the setting of significant neurologic deterioration secondary to intracranial hypotension and pneumocephalus for SPF closure via thoracic laminectomy in the prone position. We present a rare cause of pneumocephalus and CSF leak, resulting in complications and sequelae and its management.
PubMed: 38721223
DOI: 10.7759/cureus.57838 -
Surgical Neurology International 2015Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical...
BACKGROUND
Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the "Mount Fuji sign." In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition.
CASE DESCRIPTION
A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.
CONCLUSION
The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.
PubMed: 26500801
DOI: 10.4103/2152-7806.166195