RESUMO
RATIONALE: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. PATIENT CONCERNS: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. DIAGNOSIS: Emergency brain computed tomography revealed massive pneumocephalus. INTERVENTIONS: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. OUTCOMES: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. LESSONS: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16âdays after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.
Assuntos
Neoplasias Ósseas , Descompressão Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Vértebras Torácicas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Descompressão Cirúrgica/métodos , Diuréticos Osmóticos/administração & dosagem , Drenagem/métodos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Manitol/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neuroimagem/métodos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Pneumocefalia/fisiopatologia , Pneumocefalia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Reoperação/efeitos adversos , Reoperação/métodos , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do TratamentoAssuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Zumbido/fisiopatologia , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Pneumocefalia/diagnóstico , Pneumocefalia/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Zumbido/diagnósticoRESUMO
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.
Assuntos
Implante Coclear , Implantes Cocleares , Pneumocefalia , Adulto , Humanos , Masculino , Pneumocefalia/diagnóstico , Complicações Pós-Operatórias , ConvulsõesRESUMO
The purpose of the work is the analysis of etiology and pathogenesis of pneumocephaly in various injuries, diseases and pathological conditions for the reasonable determination of the severity of health damage during forensic medical examinations. The analysis of literature data on the causes and mechanisms of pneumocephaly is given. Attention is paid to the assessment of pneumocephaly in determining the health damage in patients with traumatic brain injury or if it is suspected. It is proposed to consider pneumocephaly as an indirect sign of a skull fracture. In case of pneumocephaly, a radiologically confirmed fracture is necessary to justify serious health damage. The medical documents of the victim should be examined to exclude concomitant diseases and pathological conditions that can lead to pneumocephaly.
Assuntos
Lesões Encefálicas , Pneumocefalia , Fraturas Cranianas , Autopsia , Lesões Encefálicas/diagnóstico , Humanos , Pneumocefalia/diagnósticoRESUMO
BACKGROUND: Tension pneumocephalus (TP) is a rare but feared complication of endoscopic endonasal skull base surgery. In contrast to simple pneumocephalus, which is common after endoscopic transnasal approaches and managed conservatively, TP represents a neurosurgical emergency and mandates urgent decompression. CASE DESCRIPTION: Here we present 2 cases of TP as a consequence of positive pressure ventilation following endoscopic endonasal skull base surgery. Both occurred during resuscitation for postoperative hypoxia. These cases prompted the development of an institution-wide protocol to identify and manage patients at risk of TP after extended skull base approaches. CONCLUSIONS: To our knowledge, these are the only such cases of postoperative TP following positive pressure ventilation in the literature.
Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Neoplasias Hipofisárias/cirurgia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Síndrome do Desconforto Respiratório/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Neoplasias Hipofisárias/diagnóstico , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica/métodos , Síndrome do Desconforto Respiratório/diagnóstico , Base do Crânio/cirurgia , Retalhos Cirúrgicos/cirurgiaRESUMO
We report an unusual case of a young male patient who presented with severe pain and swelling of his left eyelid following an air compressor tip accident. He suffered extensive facial edema accompanied by deep tissue emphysema and an elevated intraocular pressure. On noncontrast CT scan, air was detected in the intraconal and extraconal orbital compartments, and intracranially within the subarachnoid spaces as well as in the suprasellar and perimesencephalic cisterns. There were no detectable fractures. We presume that by perforating the orbital septum, Tenon's capsule, and the optic nerve sheath, air had managed to penetrate the cranium through the optic nerve subarachnoid space and into the intracranial subarachnoid space.
Assuntos
Lesões Acidentais/diagnóstico , Pneumocefalia/diagnóstico , Lesões Acidentais/complicações , Adulto , Humanos , Masculino , Órbita/diagnóstico por imagem , Órbita/patologia , Pneumocefalia/etiologia , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia , Tomografia Computadorizada por Raios XRESUMO
We report an interesting case of maxillary sinus pneumocele that presented with aesthetic deformity and completely treated with Caldwell-Luc approach and thoroughly review all of the past literature focusing on clinical symptoms and surgical approach. Based on our comprehensive review of maxillary sinus pneumocele, we found 2 important characteristics. First, maxillary sinus pneumocele may be asymptomatic but cause various symptoms owing to the displacement of neighboring structures, such as facial symptoms, eye symptoms, and nasal obstruction. Second, there is no standard operation technique for maxillary sinus pneumocele, but surgical approach should be individualized depending on patient's symptoms and needs. Therefore, more case studies are needed to confirm this.
Assuntos
Embolia Aérea/diagnóstico , Deformidades Adquiridas Nasais/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Pneumocefalia/diagnóstico , Diagnóstico Diferencial , Embolia Aérea/etiologia , Estética , Humanos , Masculino , Seio Maxilar/anormalidades , Seio Maxilar/patologia , Deformidades Adquiridas Nasais/complicações , Doenças dos Seios Paranasais/etiologia , Pneumocefalia/etiologia , Adulto JovemAssuntos
Pneumocefalia/diagnóstico por imagem , Pneumocefalia/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/fisiopatologia , Doenças Orbitárias/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Vômito/etiologiaAssuntos
Seio Frontal/lesões , Cefaleia/diagnóstico , Hipotensão Intracraniana/diagnóstico , Pneumocefalia/diagnóstico , Espirro , Idoso , Seio Frontal/diagnóstico por imagem , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Hipotensão Intracraniana/terapia , Imageamento por Ressonância Magnética , Masculino , Pneumocefalia/etiologia , Pneumocefalia/terapiaRESUMO
BACKGROUND: Most patients with bilateral chronic subdural hematomas (bCSDH) undergo initial bilateral evacuation. Risk factors associated with the recurrence of bCSDH after initial bilateral evacuation have not been published to date. In this study, we aimed to identify risk factors related to recurrence of bCSDH after initial bilateral evacuation, and to develop a prognostic grading system for clinical reference. METHODS: This study included 102 patients with bCSDH who underwent initial bilateral evacuation. Predictors of recurrence were identified via univariate analysis and multivariate logistic regression analysis. A prognostic grading system was created based on the independent predictors combined with a cutoff value. All cases were scored according to the prognostic grading system, and the recurrence rates of the different scores were reanalyzed. RESULTS: Anticoagulant use (odds ratio [OR], 84.266; 95% confidence interval [CI], 13.113-541.522; P < 0.001), severe brain atrophy (OR, 11.551; 95% CI, 2.558-52.163; P = 0.001), and postoperative pneumocephalus volume (PostPV) (OR, 0.978; 95% CI, 0.957-1.000; P = 0.049) were independent risk factors for the recurrence of bCSDH after initial bilateral evacuation. The cutoff value of PostPV was >20.9484 cm3. A prognostic grading system was then developed, and the recurrence rates based on score were determined. Rates were 2.8% for a score of 0-1, 28.1% for a score of 2-3, and 100% for a score of 4-5, showing a significant increase in risk with increasing score (P < 0.001). CONCLUSIONS: Anticoagulant use, severe brain atrophy, and PostPV were identified as independent risk factors for recurrence of bCSDH after initial bilateral evacuation. The prognostic grading system for recurrence of bCSDH after initial bilateral evacuation is reliable and applicable for clinical reference.
Assuntos
Encéfalo/cirurgia , Hematoma Subdural Crônico/diagnóstico , Hematoma Subdural Crônico/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Atrofia/complicações , Atrofia/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Hematoma Subdural Crônico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/complicações , Pneumocefalia/diagnóstico , Complicações Pós-Operatórias/etiologia , Recidiva , Fatores de Risco , Sensibilidade e EspecificidadeAssuntos
Fístula/diagnóstico , Fístula/cirurgia , Pneumocefalia/diagnóstico , Couro Cabeludo/patologia , Adulto , Fístula/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Processo Mastoide/patologia , Pneumocefalia/diagnóstico por imagem , Couro Cabeludo/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Autoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.Case reportThis paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously. CONCLUSION: A literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.
Assuntos
Ventilação da Orelha Média/efeitos adversos , Doenças Orbitárias/etiologia , Otite Média com Derrame/terapia , Pneumocefalia/etiologia , Enfisema Subcutâneo/etiologia , Testes de Impedância Acústica , Idoso , Endoscopia , Tuba Auditiva , Feminino , Humanos , Ventilação da Orelha Média/instrumentação , Doenças Orbitárias/diagnóstico , Pneumocefalia/diagnóstico , Autocuidado , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Analgesia Epidural/efeitos adversos , Cefaleia/diagnóstico , Pneumocefalia/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Analgesia Epidural/métodos , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Cefaleia/etiologia , Humanos , Pneumocefalia/etiologia , Período Pós-Parto , Gravidez , Complicações na Gravidez/etiologiaRESUMO
Tension pneumocephalus is a rare but dangerous complication of craniotomy, sinus surgery, and traumatic cranial injury. Compared with simple pneumocephalus, which often resolves spontaneously over the course of a few days, tension pneumocephalus tends to increase with ongoing cerebrospinal fluid leak and requires immediate neurosurgical treatment to prevent cerebral herniation. Air transport of patients with tension pneumocephalus for neurosurgical care entails a risk of neurologic worsening because of changes in ambient air pressure with altitude and cabin pressurization. We describe a case in which severe symptomatic tension pneumocephalus developed after endoscopic endonasal sinus surgery in an 81-year-old man. The patient lived in a remote area and required air transport for medical care. Pretreatment with oxygen therapy and maintaining the patient in a flat supine position rapidly improved his neurologic status, allowing transportation without incidence. A recommendation was also made to the medical transport team to fly at the lowest possible altitude. Specific precautions may enable safe transport of these critically ill patients for treatment, although further data must be obtained before these can be definitively recommended.
Assuntos
Resgate Aéreo , Encefalocele/terapia , Pneumocefalia/terapia , Idoso de 80 Anos ou mais , Encefalocele/diagnóstico , Encefalocele/etiologia , Humanos , Masculino , Pneumocefalia/complicações , Pneumocefalia/diagnósticoRESUMO
BACKGROUND: Ventricular pneumocephalus is a rare but potentially life-threatening complication of cranial surgery in the sitting position. OBJECTIVE: The objective of the study is to assess the incidence and risk factors of postoperative ventricular pneumocephalus. METHODS: We performed a retrospective chart review of 307 consecutive patients (147 men, 160 women) treated at our institution by intracranial surgery in the sitting position from January 2010 to October 2014. Ventricular air entrapment with lack of arousal or neurologic deterioration requiring external ventriculostomy (EVD) was defined as ventricular tension pneumocephalus (VTP). Demographic variables were recorded along with radiological and clinical data. The occurrence of pneumocephalus was correlated with patient-related and surgical variables. RESULTS: VTP was observed in 12 cases (3.9%). These patients had higher intraventricular air volumes (48.5 cm3 (CI 95% [29.06-67.86])) compared to asymptomatic patients (7.4 cm3 (CI 95% [5.43-9.48])). Opening of the fourth ventricle was the most potent predictor of VTP (OR = 34.7, CI 95% [4.4-273.5], p = 0.001). In patients undergoing no additional treatment for pneumocephalus, ventricular air volume declined to an average of 41.7% of the initial postoperative volume on postoperative day 3. CONCLUSIONS: Entrapment of intracranial and particularly ventricular air requiring emergent EVD occurred in 3.9% cases of intracranial surgery in the sitting position. Especially the opening of the fourth ventricle was associated with the development of VTP, which should warrant particularly diligent postoperative observation of these patients. In cases without neurological symptoms, the rate of spontaneous air resorption is sufficiently high to warrant expectant management.
Assuntos
Fossa Craniana Posterior/cirurgia , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico , Postura Sentada , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Quarto Ventrículo/cirurgia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Pneumocefalia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Ventriculostomia , Adulto JovemRESUMO
BACKGROUND: Tension pneumocephalus is a rare but life-threatening condition in which air gains entry into the cranium and exerts mass effect on the brain, resulting in increased intracranial pressure. It occurs most frequently secondary to head trauma, particularly to the orbits or sinuses. CASE REPORT: A 13-year-old male sustained facial trauma from a motor vehicle collision and was found to have tension pneumocephalus on computer tomography. The patient underwent immediate rapid sequence intubation without preceding positive pressure ventilation in the emergency department. At the time of his craniotomy, the tension pneumocephalus was found to have resolved and he went on to have a complete recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Any patient with facial or head trauma and pneumocephalus is at risk for the potential development of tension pneumocephalus. When present, we advocate that aggressive definitive airway management by rapid sequence intubation without preceding positive pressure ventilation and early surgical management should be prioritized.
Assuntos
Hipertensão Intracraniana/cirurgia , Pneumocefalia/diagnóstico , Pneumocefalia/terapia , Acidentes de Trânsito , Doença Aguda/terapia , Adolescente , Craniotomia/métodos , Humanos , Masculino , Medicina de Emergência Pediátrica/métodos , Pneumocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
Pneumoventricle and liquoric fistula are possible complications of traumatic brain injury (TBI), the main cause of morbimortality related to trauma in Brazil. Liquoric fistulae are more common after direct trauma with skull base fractures. However, pneumoventricle is rare and occurs due to excessive cerebrospinal fluid (CSF) drainage in the presence of a poorly compliant ventricle system, resulting in the influx of air to its interior. The pathophysiology of tension pneumoventricle remains uncertain. However, the traumatic cause is certain andmultiple bone fractures of the face and liquoric fistula may contribute to the process. If symptomatic, the tension pneumoventricle can cause rapid clinical deterioration. The authors aim to report a rare case of post-TBI tension pneumoventricle with complete resolution and without signs of recurrence of the liquoric fistula after surgical treatment.
Assuntos
Humanos , Masculino , Adulto , Pneumocefalia/etiologia , Traumatismos Craniocerebrais/complicações , Pneumocefalia/cirurgia , Pneumocefalia/diagnóstico , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologiaAssuntos
Encéfalo/diagnóstico por imagem , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Transtornos da Cefaleia/etiologia , Pneumocefalia/complicações , Adulto , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Transtornos da Cefaleia/diagnóstico , Transtornos da Cefaleia/cirurgia , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Pneumocefalia/diagnóstico , Pneumocefalia/cirurgia , Tomografia Computadorizada por Raios XRESUMO
We describe a patient with pneumocephalus following an epidural steroid injection (ESI) who presented with altered mental status, headache, focal neurologic findings and seizures. Pneumocephalus has rarely been described following ESI. A 34-year-old female presented with an altered level of consciousness worsening over approximately 18h following an ESI for lumbar back pain. She had associated headache, right-sided facial twitching and right upper extremity weakness. A brain CT scan revealed pneumocephalus in the right lateral ventricle and quadrigeminal plate cistern. While in the emergency department she experienced a self-limited generalized seizure. She was admitted and her symptoms persisted. Seven days following admission she was discharged to a rehabilitation facility, but her arm weakness persisted for greater than a month before resolving. Epidural anesthesia relies on the localization of the epidural space. The manual loss of resistance technique is widely used to identify the epidural space. The incidence of adverse effects is unknown. Case reports noting complications associated with this technique have been reported; rarely including pneumocephalus. Complications from the pneumocephalus are even less commonly reported. Though rare following an ESI and generally self-limited without complication, pneumocephalus should be considered in the differential diagnosis when evaluating a patient with neurologic deficits after instrumentation.