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1.
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
4.
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
5.
World Neurosurg ; 138: 201-204, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32179190

RESUMO

BACKGROUND: Hydrogen peroxide (H2O2) solution is commonly used to irrigate wounds because of its hemostatic and antiseptic properties. Previous studies suggest that H2O2 can result in toxicity to keratinocytes and fibroblasts, but complications after H2O2 application, including oxygen embolism, which is one of the most severe, have rarely been reported. CASE DESCRIPTION: A 40-year-old woman was diagnosed with L4-5 lumbar spinal stenosis and subsequently underwent minimally invasive transforaminal lumbar interbody fusion treatment at another hospital. Hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occurred immediately after H2O2 irrigation. After the operation, she was able to be extubated but remained comatose. Postoperative computed tomography scan revealed intracranial air trapping in the right frontal lobe and multiple cerebral infarction foci. CONCLUSIONS: When using a knee-prone surgical position or in cases of dural laceration, the application of undiluted H2O2 solution should be avoided, especially in a surgical wound within a closed cavity. When hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occur immediately after H2O2 irrigation, oxygen embolism should be strongly suspected.


Assuntos
Anti-Infecciosos Locais/efeitos adversos , Embolia Aérea/etiologia , Peróxido de Hidrogênio/efeitos adversos , Pneumocefalia/etiologia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos , Adulto , Feminino , Humanos , Vértebras Lombares , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Oxigênio , Estenose Espinal/cirurgia
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
9.
Neurosurg Rev ; 43(1): 95-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31897886

RESUMO

Deep brain stimulation has become an established therapeutic choice to manage the symptoms of medically refractory Parkinson's disease. Its efficacy is highly dependent on the accuracy of electrodes' positioning in the correct anatomical target. During DBS procedure, the opening of the dura mater induces the displacement of neural structures. This effect mainly depends on the loss of the physiological negative intracranial pressure, air inflow, and loss of cerebrospinal fluid. Several studies concentrated on correcting surgical techniques for DBS electrodes' positioning in order to reduce pneumocephalus which may result in therapeutic failure. The authors focused in particular on reducing the brain air window and maintaining the pressure gradient between intra- and extracranial compartments. A significant reduction of pneumocephalus and brain shift was obtained by excluding the opening of the subarachnoid space, by covering the dura mater opening with tissue sealant and by reducing the intracranial pressure in general anesthesia. Smaller burr hole diameters were not statistically relevant for reducing air inflow and displacement of anatomical targets. The review of the literature showed that conserving a physiological intra-extracranial pressure gradient plays a fundamental role in avoiding pneumocephalus and consequent displacement of brain structures, which improves surgical accuracy and DBS long-term results.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Pneumocefalia/prevenção & controle , Estimulação Encefálica Profunda/efeitos adversos , Humanos , Pneumocefalia/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Trepanação
10.
Acta Neurochir (Wien) ; 162(3): 509-512, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31925539

RESUMO

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 X
11.
Pediatr Neurosurg ; 55(1): 51-53, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31661699

RESUMO

The mitogen-activated protein kinase (MAPK) pathway consists of the Ras/Raf/MEK/ERK signaling cascade, and its upregulation plays a major role in the pathogenesis of pediatric astrocytomas and molecular inhibitors of this pathway including trametinib and dabrafenib have been tested in early-phase clinical trials and used by pediatric oncologists in children with BRAF-mutated gliomas. We report a clinical case where a child with progressive BRAF-mutated glioma developed an uncommon and difficult to manage complication - pneumocephalus from intracranial air entry and trapping through dehisced surgical wounds and preexisting skull burr holes. The patient's wound breakdown coincided with skin toxicity from MEK inhibitor therapy. With increasing use of targeted molecular inhibitors in pediatric neuro-oncology, this case illustrates the potentially complicated course of MEK inhibitor therapy in patients with scalp surgical wounds and burr holes that were placed within few weeks from initiation of drug therapy, especially if patients have additional factors that can contribute to poor wound healing such as use of steroids and malnutrition.


Assuntos
Glioma/tratamento farmacológico , Pneumocefalia/etiologia , Inibidores de Proteínas Quinases/efeitos adversos , Piridonas/efeitos adversos , Pirimidinonas/efeitos adversos , Deiscência da Ferida Operatória/etiologia , Pré-Escolar , Feminino , Humanos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos
12.
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
13.
Int Forum Allergy Rhinol ; 9(10): 1089-1096, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31403759

RESUMO

BACKGROUND: Spontaneous skull base defects can result in life-threatening intracranial complications (ICCs), including meningitis and pneumocephalus. Endoscopic skull base reconstruction (ESBR) has traditionally been the treatment of choice, but its impact upon ICCs is not known. In this study, we aimed to describe the incidence rate of preoperative ICCs in patients with spontaneous skull base defects, risk factors associated with ICC development, and the impact of surgical repair on the incidence rate of ICCs. METHODS: A retrospective review was performed of all spontaneous skull base defects undergoing ESBR from 2005 to 2019 at 2 academic tertiary care medical centers. The incidence rate of ICCs and the demographics information and risk factors were collected. RESULTS: In 222 spontaneous skull base defects, preoperative ICCs occurred in 46 subjects (20.7%) with an incidence rate of 22.7 per 100 person-years. Factors significantly associated with preoperative ICCs included symptom duration, reduced body mass index (BMI), resolved cerebrospinal fluid rhinorrhea, and location in the frontal or lateral sphenoid sinuses. Endoscopic repair was successful in 97.2% of subjects and the postoperative ICC incidence rate was significantly reduced at 0.8 per 100 person-years (p < 0.001). CONCLUSION: Spontaneous skull base defects pose significant risk for life-threatening ICCs. Our findings reveal significantly elevated odds of ICC development associated with resolved CSF rhinorrhea, lower BMI, longer duration of symptoms, and defect location. Endoscopic repair is highly successful with low morbidity and significantly reduces the incidence rate of intracranial complications.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Meningite/prevenção & controle , Pneumocefalia/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos , Convulsões/prevenção & controle , Base do Crânio/cirurgia , Adulto , Vazamento de Líquido Cefalorraquidiano/complicações , Feminino , Humanos , Incidência , Masculino , Meningite/etiologia , Pessoa de Meia-Idade , Pneumocefalia/etiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia
14.
J Craniofac Surg ; 30(8): 2536-2538, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261322

RESUMO

Anterior epistaxis is commonly treated with Merocel nasal packing insertion. A 63-year-old male patient showed a cerebrospinal fluid rhinorrhea and pneumocephalus immediately after insertion of a Merocel tampon used for spontaneous right anterior epistaxis. He later developed fever and headache. This clinical report is to highlight how the nasal merocel should be positioned by specialized personnel and to describe how to manage this type of complication.


Assuntos
Epistaxe , Rinorreia de Líquido Cefalorraquidiano/etiologia , Epistaxe/etiologia , Formaldeído , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/etiologia , Álcool de Polivinil
16.
World Neurosurg ; 130: e344-e349, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31229753

RESUMO

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.


Assuntos
Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
17.
Br J Oral Maxillofac Surg ; 57(6): 587-589, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31085015

RESUMO

We report a case of unilateral Keros type III variant of the cribriform plate (olfactory fossa >7 mm deep) that caused non-traumatic pneumocephalus. A 61-year-old male patient presented to the emergency room complaining of acute-onset headache after blowing his nose. Computed tomographic (CT) examination showed a massive pneumocephalus; a CT scan from three months before showed a Keros type III variant. The defect was repaired endoscopically with mucoperichondrial and mucoperiostal grafts. Pneumocephalus that has developed in a Keros type III variant has been theorised about, but never reported to our knowledge. Radiologists should be familiar with the Keros classification so that they can identify patients who are at increased risk of fractures of the cribriform plate.


Assuntos
Osso Etmoide , Fraturas Ósseas , Pneumocefalia , Osso Etmoide/lesões , Fraturas Ósseas/complicações , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Pneumocefalia/etiologia , Tomografia Computadorizada por Raios X
18.
J Clin Sleep Med ; 15(5): 781-783, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-31053214

RESUMO

ABSTRACT: Pneumocephalus, or air within the cranium, can be caused by trauma, intracranial infections, or tumors, and can also occur as a complication of neurosurgery and lumbar puncture. Continuous positive airway pressure (CPAP) therapy can precipitate or worsen pneumocephalus in cases of known head trauma. However, nontraumatic pneumocephalus being caused by CPAP is a highly unexpected clinical event. We describe a case of a patient who presented with meningitis due to an atypical organism that usually resides in the oral cavity, and who developed nontraumatic pneumocephalus in the hospital due to CPAP therapy. The underlying cause, a cerebrospinal fluid leak, was likely the mediator for both pathologies. In the setting of the increasing prevalence of obstructive sleep apnea, physicians can benefit from being aware of this atypical presentation of meningitis and atypical complication of CPAP therapy.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Meningite/complicações , Pneumocefalia/etiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Doença Iatrogênica , Meningite/tratamento farmacológico , Pneumocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
Aerosp Med Hum Perform ; 90(6): 566-569, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31101142

RESUMO

BACKGROUND: Pneumocephalus is intracranial air normally occurring as a consequence of trauma or cranial surgery, but rarely has been reported following the habitual use of the Valsalva maneuver. We were unable to locate any similar cases of pneumocephalus associated with high performance aircraft flight, and this case report highlights an important consequence of the inappropriate use of Valsalva on ascent to altitude.CASE REPORT: A healthy 29-yr-old F-22 instructor pilot presented with recurrent pneumocephalus following the use of the Valsalva maneuver. These episodes started after an initial use of a forceful Valsalva during an aggressive unrestricted climb to altitude. His symptoms included facial pressure and a bubbling sensation in his head followed by a severe headache for several days. After upright CT evaluation, three small sphenoid sinus defects were discovered and repaired. There was no recurrence of pneumocephalus following provocative testing after surgical repair of the sphenoid sinus defects, and the aviator returned to flying high performance aircraft.DISCUSSION: Spontaneous or Valsalva-associated pneumocephalus is an uncommon occurrence in healthy individuals. Awareness of the pathognomonic succussion splash associated with this diagnosis as well as a presentation of facial pressure and headache following flight will lead to appropriate diagnostic investigation and management. This case highlights the importance of recognizing rare diagnoses like pneumocephalus in the flying population, and future education of aerospace physiology technicians and aviators should emphasize appropriate Valsalva technique to promote flying safety and prevent similar presentations.Woodside SS, Metzler MM. Pneumocephalus associated with inappropriate Valsalva technique. Aerosp Med Hum Perform. 2019; 90(6):566-569.


Assuntos
Transtornos da Cefaleia Primários/etiologia , Pneumocefalia/etiologia , Manobra de Valsalva , Medicina Aeroespacial , Altitude , Transtornos da Cefaleia Primários/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Masculino , Pilotos , Pneumocefalia/diagnóstico por imagem , Recidiva , Seio Esfenoidal/diagnóstico por imagem
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