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2.
Middle East Afr J Ophthalmol ; 27(2): 142-144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874051

RESUMO

A cerebrospinal fluid (CSF) leak is a rare complication after orbital surgery. We reported a 49-year-old man who presented with CSF leakage after transcaruncular medial wall decompression for proptosis due to thyroid eye disease. He underwent an endoscopic endonasal approach to surgical repair of the defect with nasoseptal flap. Rhinorrhea was stopped immediately after endoscopic repair.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Oftalmopatia de Graves/cirurgia , Pneumocefalia/etiologia , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Exoftalmia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X
5.
J Clin Neurosci ; 75: 218-220, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249175

RESUMO

Pneumocephalus describes the presence of air within the cranial cavity and is often self-limiting. Tension pneumocephalus is a neurosurgical emergency manifested by headaches, seizures, reduced consciousness and even death resulting from raised intracranial pressure. Differentiating both entities clinically is often challenging but crucial. We present a case involving a sixty-year-old male who was transferred to our unit after he collapsed while undergoing rehabilitation. The patient had undergone a combined bifrontal craniotomy and transnasal endoscopic resection of recurrent sinonasal adenocarcinoma with anterior skull base involvement eight days prior. Imaging demonstrated the classic Mt. Fuji sign and a diagnosis of tension pneumocephalus was formed. The patient proceeded for definitive management which included a multi-layered repair of the anterior skull base. The three mechanisms that propose the development of tension pneumocephalus include the ball-valve mechanism, the inverted soda-bottle effect and rarely, infection from gas forming organisms. A review of current literature on PubMed/MEDLINE revealed tension pneumocephalus after skull base surgery to be a rare entity with only eleven cases reported. Most patients achieved complete recovery of symptoms post-treatment. Clinicians should recognise tension pneumocephalus as a potential complication after skull base surgery. Accurate diagnosis requires appreciation of imaging features and a high index of suspicion. Prompt management is imperative to prevent possible devastating outcomes.


Assuntos
Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Craniotomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos
6.
World Neurosurg ; 138: 253-256, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32194265

RESUMO

BACKGROUND: Intracranial pneumocephalus, the accumulation of air, occurs most frequently from trauma, tumor, cranial surgeries, or infection. Intraparenchymal otogenic pneumocephalus is a rare but well-documented development. We describe a patient who developed pneumocephalus in the context of eardrum perforation secondary to toothpick use for ear wax. CASE DESCRIPTION: An 86-year-old female presented to the emergency room with a 1-day history of dysarthria and a few days of cough and sneezing. History revealed she had recently been advised to avoid Q-Tips to clean her ears and instead was using toothpicks. She denied otalgia or otorrhea and had no signs of infection near the ear. On otoscopic examination, the right tympanic membrane was perforated. On head computed tomography, she was found to have a large right temporal pneumocephalus extending from the petrous bone. Magnetic resonance imaging of the brain revealed a defect in the right tegmen. She was started on empiric antibiotics and subsequently taken to the operating room for craniotomy and repair of bony and dural defects. CONCLUSIONS: Otogenic pneumocephalus is a rare occurrence. This is the first reported case of pneumocephalus related to self-induced middle ear trauma with a toothpick that ultimately required craniotomy for repair.


Assuntos
Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Membrana Timpânica/lesões , Idoso de 80 Anos ou mais , Dispositivos para o Cuidado Bucal Domiciliar , Feminino , Humanos , Pneumocefalia/diagnóstico por imagem
8.
BMJ Case Rep ; 13(2)2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32071126

RESUMO

A previously healthy young man presented to hospital with severe traumatic brain injury following a motor vehicle collision. Within 24 hours of admission, and despite antibiotic coverage, he developed a fever. On the second day, the source of infection was discovered to be purulent pneumococcal meningitis. At 48 hours post-accident, he developed brain-stem death without evidence of raised intracranial pressure or trans-tentorial herniation. Initial CT scans of the head were essentially normal, but early repeat scans revealed evidence of pneumocephalus and possible frontal bone fracture. Current recommendations do not make room for targeted antibiotic prophylaxis in traumatic brain injury patients with traumatic skull fracture. We argue that our case demonstrates the need for aggressive targeted antibiotic prophylaxis in the presence of certain features such as frontal or sphenoid bone fracture and pneumocephalus.


Assuntos
Lesões Encefálicas Traumáticas/microbiologia , Meningite Pneumocócica/tratamento farmacológico , Pneumocefalia/microbiologia , Fraturas Cranianas/microbiologia , Acidentes de Trânsito , Antibacterianos/uso terapêutico , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Dexametasona/uso terapêutico , Diagnóstico Diferencial , Evolução Fatal , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Adulto Jovem
9.
Medicine (Baltimore) ; 99(5): e18654, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000370

RESUMO

INTRODUCTION: Acute hydrocephalus is a common complication of spontaneous or traumatic intracranial bleeding with extensive subarachnoid hemorrhage (SAH) or ventricular extension. However, it has never been reported to be secondary to pneumocephalus. PATIENT CONCERNS: A 32-year-old man was admitted following a motorcycle accident. Head computed tomography (CT) performed right after the accident revealed a skull base fracture and mild perimesencephalic SAH. Three days later, repeated CT revealed delayed perimesencephalic pneumocephalus and an evident enlargement of the ventricular system. DIAGNOSIS: The patient was diagnosed with acute obstructive hydrocephalus, which was secondary to pneumocephalus and traumatic SAH. INTERVENTIONS: The patient was treated with temporary external ventricular drainage (EVD). OUTCOMES: The patient experienced an unremarkable recovery process. At follow-up 3 months later, he showed no recurrence of the hydrocephalus and the score of Glasgow Outcome Scale was 5. CONCLUSION: Transient mechanical obstruction of CSF circulation and disturbance of CSF physiology might conjointly lead to the acute obstructive hydrocephalus.


Assuntos
Hidrocefalia/etiologia , Pneumocefalia/complicações , Fratura da Base do Crânio/complicações , Hemorragia Subaracnóidea/complicações , Acidentes de Trânsito , Adulto , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Fratura da Base do Crânio/diagnóstico por imagem
11.
World Neurosurg ; 134: e1121-e1129, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786379

RESUMO

BACKGROUND: Patients requiring deep brain stimulation (DBS) will undergo extensive preoperative and postoperative evaluations. However, the field lacks a robust scoring system for quantifying the outcomes of DBS surgery. We sought to determine whether a practical scale could assess the outcomes of DBS surgery and the clinical significance. METHODS: A retrospective study was performed of the data from 150 patients who had undergone DBS from February 2017 to February 2019. An independence analysis and multivariate testing were used to identify significant independent predictors. The scale scores were computed by summing across the weighted predictors. The correlation between the scale scores and the intraoperative electrophysiological signal length (IESL), DBS power-on voltage, improvement rate in the unified Parkinson disease rating scale (UPDRS) and UPDRS part III (UPDRS III) scores was analyzed. Receiver operating characteristics curve analysis was used to quantify the discriminative capacity of the scale for predicting the prognosis. RESULTS: Listwise exclusion of patients with incomplete data sets yielded a final sample of 130 patients with Parkinson disease who had undergone bilateral DBS. Multivariate testing identified 3 independent predictors of the prognosis, including electrode implantation duration, postoperative pneumocephalus volume, and electrode fusion error. The scale scores correlated significantly with the subthalamic nucleus DBS power-on voltage (r = -0.4063; P < 0.0001), globus pallidus internus DBS power-on voltage (r = -0.4723; P = 0.0014), and improvement rate of the UPDRS (r = 0.3490; P < 0.0001) and UPDRS III (r = 0.6623; P < 0.0001) scores. However, the scale scores did not significantly correlate with the subthalamic nucleus IESL and globus pallidus internus IESL. Receiver operating characteristics curve analysis revealed impressive outcome discrimination for the UPDRS and UPDRS III scores (UPDRS: area under the curve, 0.62, P = 0.0219; UPDRS III: area under the curve, 0.85, P < 0.0001). CONCLUSIONS: We have introduced a novel practical scale capable of assessing the outcomes of DBS surgery and predicting the prognosis of patients after DBS surgery.


Assuntos
Estimulação Encefálica Profunda , Globo Pálido/cirurgia , Doença de Parkinson/terapia , Implantação de Prótese , Núcleo Subtalâmico/cirurgia , Idoso , Feminino , Humanos , Neuroestimuladores Implantáveis , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Duração da Cirurgia , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Prognóstico , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
World Neurosurg ; 135: 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863895

RESUMO

BACKGROUND: Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. CASE DESCRIPTION: A 66-year-old woman had presented with a Rathke cleft cyst. The patient underwent transsphenoidal surgery (TSS), with no clinical cerebrospinal fluid leakage observed peri- or postoperatively. However, she developed an altered mental status 8 hours after surgery, and a computed tomography scan showed evidence of a tension pneumoventricle. The patient underwent emergent external ventricular drainage insertion and exploratory endoscopic TSS. A 1-way valve was observed during TSS, and the sella floor was packed with a fat graft for 1-way valve obliteration. The patient recovered well without neurologic deficits. No radiologic regrowth was noted at the 48-month follow-up examination. CONCLUSIONS: Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Sela Túrcica/cirurgia , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Imagem por Ressonância Magnética , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide , Tomografia Computadorizada por Raios X , Ventriculostomia
14.
Artigo em Inglês | MEDLINE | ID: mdl-31700684

RESUMO

Introduction: We report a case of pneumocephalus and pneumorachis i.e., air in the cranial cavity and the spinal canal, which are rarely associated with a primary spinal cause. Their concomitant occurrence and association with a late presenting dural leak are also uncommon. Case presentation: A 70-year-old man presented 1 month after decompressive surgery for lumbar canal stenosis with leakage of cerebrospinal fluid (CSF) from the wound site and severe headache. There were no signs of surgical site infection or meningitis. There was no intraoperative or immediate postoperative evidence of dural tear. He was neurologically intact. On detailed work-up, he was found to have air collections in the subarachnoid and intraventricular spaces in the brain and intraspinal air in both the cervical and the lumbar regions. He showed gradual resolution of these findings radiologically and symptomatic improvement through conservative management with analgesics, empirical antibiotics, high flow oxygen, and maintenance of hydration within 1 month. Discussion: Pneumocephalus and pneumorachis are commonly seen after trauma. Spine surgery is a rare cause. They may present with symptoms similar to meningitis and may be erroneously diagnosed and treated. No standard treatment guidelines exist in the literature. Most cases have been managed conservatively. Early detection may allow noninvasive management leading to complete resolution.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Pneumocefalia/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Vazamento de Líquido Cefalorraquidiano/complicações , Dura-Máter , Humanos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Neurocirúrgicos/tendências , Pneumocefalia/complicações , Pneumorraque/complicações , Complicações Pós-Operatórias/etiologia , Fatores de Tempo
15.
J Med Case Rep ; 13(1): 317, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31651338

RESUMO

BACKGROUND: Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures. CASE DESCRIPTION: We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient's state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37. CONCLUSIONS: This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.


Assuntos
Acidentes de Trânsito , Pneumocefalia/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Idoso de 80 Anos ou mais , Evolução Fatal , Hemopneumotórax/diagnóstico por imagem , Hemopneumotórax/etiologia , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Insuficiência de Múltiplos Órgãos/etiologia , Pneumocefalia/etiologia , Pneumonia Associada à Ventilação Mecânica/complicações , Pneumorraque/etiologia , Choque Hemorrágico/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios X , Imagem Corporal Total
17.
World Neurosurg ; 131: 112-115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31382061

RESUMO

BACKGROUND: Pneumocephalus is a rare complication after an elective lumbar spine surgery. Full endoscopic lumbar diskectomy (FELD) is an evolving minimally invasive surgical procedure gaining its popularity in the past decade. Although seizure was recognized as a possible complication, organic injury to the central nervous system such as pneumocephalus has not yet been reported after FELD. CASE DESCRIPTION: A 63-year-old man with L3-4 intervertebral disk herniation received FELD via the transforaminal approach under general anesthesia. A small dural tear about 2 mm was encountered. After the operation, the patient was unable to recover from anesthesia and failed to be extubated due to tachypnea and generalized tonic-clonic seizures. Emergent brain computed tomography (CT) revealed pneumocephalus in the subdural and subarachnoid space. Pure oxygen was given, and hyperbaric oxygen therapy (HBO2) was arranged immediately. Fortunately, he started to regain his consciousness 8 hours after the operation and had full recovery of consciousness on the next day. Follow-up brain CT showed nearly complete resolution of the pneumocephalus. He had no neurologic deficits at final follow-up. CONCLUSIONS: This case report highlights the risk of pneumocephalus with conscious disturbance when a dural tear occurs during FELD under general anesthesia. FELD is safer when performed under local anesthesia because the patient is awake to report his discomfort and thus possible to prevent serious neurologic sequels. An emergent brain CT is critical to obtain a prompt diagnosis and HBO2 is probably helpful for resolving the mass effect caused by the pneumocephalus.


Assuntos
Transtornos da Consciência/fisiopatologia , Discotomia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Neuroendoscopia , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Transtornos da Consciência/etiologia , Humanos , Oxigenação Hiperbárica , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Pneumocefalia/complicações , Pneumocefalia/terapia , Complicações Pós-Operatórias/terapia
19.
J Comput Assist Tomogr ; 43(5): 686-689, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356520

RESUMO

BACKGROUND: The Mount Fuji sign (MFS) is a radiological sign on computed tomographic scans depicting air between the frontal lobes. Air in this location indicates tension pneumocephalus (TP), considered a neurosurgical emergency.We evaluate the correlation between the MFS and perioperative mortality attributed to TP in nonagenarians who have undergone evacuation of chronic subdural hemorrhage (cSDH). MATERIALS AND METHODS: We retrospectively reviewed the records of nonagenarians who had cSDH evacuation between 2006 and 2015. Postoperative computed tomographic images were evaluated for findings consistent with the MFS. RESULTS: Of 45 patients, 15 patients (33%) had radiological MFS, and 3 patients (20%) with MFS required reoperation because of new blood collection. No patient required reoperation because of TP. Perioperative (30-day) mortality in patients demonstrating the MFS was 6.67% caused by cardiac arrhythmia versus 13.33% mortality in patients with no evidence of the MFS. CONCLUSION: Mount Fuji sign in nonagenarians after cSDH evacuation is not a specific sign of TP.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Feminino , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Pneumocefalia/mortalidade , Reoperação , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
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