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1.
Bratisl Lek Listy ; 124(1): 3-11, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36519601

RESUMO

OBJECTIVES: To identify risk factors for unilateral non-acute subdural hematomas NASH recurrence, as well as to perform volumetric quantitative analysis of hematoma, postoperative pneumocephalus and extent of hematoma evacuation. BACKGROUND: Recurrence of NASH increases morbidity and mortality and has negative socio-economic consequences. Its accurate prediction could improve patient specific care. METHODS: Records of 102 patients after unilateral NASH evacuation during the period from 2014 to 2020 with a 4-month follow-up were evaluated. Impacts of preoperative clinical signs and factors on the incidence of NASH recurrence were evaluated, namely those of age, gender, timing of surgery, hematoma side, surgical technique (number of burr holes, trepanation versus craniotomy), duration of drainage, antithrombotic agents, morphological type of hematoma, preoperative hematoma volume (PHV), post-evacuation hematoma cavity volume (PHCV), pneumocephalus volume (PCV) and extent of hematoma evacuation (EHE) on the incidence of NASH recurrence were evaluated. RESULTS: An overall recurrence rate of 13.7 % was observed. Preoperative hematoma volume, postoperative hematoma cavity volume and postoperative pneumocephalus volume had a significant impact on incidence of recurrence. CONCLUSIONS: Pre- and postoperative volumetric evaluations, of patients with NASH, particularly the measurements of preoperative hematoma volume and postoperative volume of hematoma cavity and pneumocephalus have a potential to improve the prediction of clinically significant recurrence (Tab. 6, Fig. 3, Ref. 51). Text in PDF www.elis.sk Keywords: subdural hematoma, recurrence, pneumocephalus, risk factors.


Assuntos
Hematoma Subdural Crônico , Hepatopatia Gordurosa não Alcoólica , Pneumocefalia , Humanos , Hematoma Subdural Crônico/cirurgia , Estudos Retrospectivos , Recidiva , Tomografia Computadorizada por Raios X
2.
Int J Oral Maxillofac Surg ; 51(12): 1570-1572, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35985911

RESUMO

Tension pneumocephalus is a rare complication of frontal sinus fracture or neurosurgical intervention resulting from compression of the brain by entrapped air, leading to seizure, altered mental status, brain herniation, and death. This report presents a case of traumatic tension pneumocephalus associated with an anterior and posterior table frontal sinus fracture in a patient with pneumosinus dilatans and osteogenesis imperfecta.


Assuntos
Transtornos Mentais , Pneumocefalia , Fraturas Cranianas , Humanos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/cirurgia
3.
Otol Neurotol ; 43(8): e856-e860, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35970161

RESUMO

OBJECTIVE: Cerebrospinal fluid leak and pneumocephalus are rare but potentially devastating complications associated with translabyrinthine resection of cerebellopontine angle masses. Persistent pneumocephalus despite proximal eustachian tube (ET) obliteration is rare. We describe, to our knowledge, the first report of successful management of tension pneumocephalus by endoscopic endonasal ET obliteration using a novel V-loc (Covidien; Medtronic, Minneapolis, MN) suture technique. PATIENTS: A 63-year-old man presented with altered mental status 10 months after translabyrinthine excision of a left cerebellopontine angle vestibular schwannoma measuring 2.8 × 2.9 × 3.3 cm. Computed tomography demonstrated diffuse ventriculomegaly and new pneumocephalus along the right frontal lobe, lateral ventricles, and third ventricle, and air within the left translabyrinthine resection cavity. INTERVENTION: The patient underwent left-sided endoscopic endonasal ET obliteration using 2-0, 9-inch V-loc suture. MAIN OUTCOME MEASURE: Postoperatively, the patient's mental status improved with a decrease in size of the lateral and third ventricles on computed tomography. CONCLUSION: Endoscopic endonasal ET obliteration, a technique previously applied to recalcitrant cerebrospinal fluid leaks, is a safe and reasonable alternative to reentering the original surgical site for patients with pneumocephalus after lateral skull base surgery. Utilizing a V-loc suture for this technique instead of a traditional suture may improve procedural ease and speed.


Assuntos
Tuba Auditiva , Neuroma Acústico , Pneumocefalia , Vazamento de Líquido Cefalorraquidiano/etiologia , Endoscopia/métodos , Tuba Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Neuroma Acústico/cirurgia , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/etiologia
5.
Acta Neurochir (Wien) ; 164(9): 2395-2400, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35794427

RESUMO

INTRODUCTION: Concerns arise when patients with pneumocephalus engage in air travel. How hypobaric cabin pressure affects intracranial air is largely unclear. A widespread concern is that the intracranial volume could relevantly expand during flight and lead to elevated intracranial pressure. The aim of this systematic review was to identify and summarise models and case reports with confirmed pre-flight pneumocephalus. METHODS: The terms (pneumocephalus OR intracranial air) AND (flying OR fly OR travel OR air transport OR aircraft) were used to search the database PubMed on 30 November 2021. This search returned 144 results. To be included, a paper needed to fulfil each of the following criteria: (i) peer-reviewed publication of case reports, surveys, simulations or laboratory experiments that focussed on air travel with pre-existing pneumocephalus; (ii) available in full text. RESULTS: Thirteen studies met the inclusion criteria after title or abstract screening. We additionally identified five more articles when reviewing the references. A notion that repeatedly surfaced is that any air contained within the neurocranium increases in volume at higher altitude, much like any extracranial gas, potentially resulting in tension pneumocephalus or increased intracranial pressure. DISCUSSION: Relatively conservative thresholds for patients flying with pneumocephalus are suggested based on models where the intracranial air equilibrates with cabin pressure, although intracranial air in a confined space would be surrounded by the intracranial pressure. There is a discrepancy between the models and case presentations in that we found no reports of permanent or transient decompensation secondary to a pre-existing pneumocephalus during air travel. Nevertheless, the quality of examination varies and clinicians might tend to refrain from reporting adverse events. We identified a persistent extracranial to intracranial fistulous process in multiple cases with newly diagnosed pneumocephalus after flight. Finally, we summarised management principles to avoid complications from pneumocephalus during air travel and argue that a patient-specific understanding of the pathophysiology and time course of the pneumocephalus are potentially more important than its volume.


Assuntos
Viagem Aérea , Hipertensão Intracraniana , Pneumocefalia , Humanos , Hipertensão Intracraniana/complicações , Pressão Intracraniana , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/terapia
6.
Sci Rep ; 12(1): 10482, 2022 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-35729166

RESUMO

Only few studies have assessed brain shift caused by positional change. This study aimed to identify factors correlated with a large postneurosurgical positional brain shift (PBS). Sixty-seven patients who underwent neurosurgical procedures had upright computed tomography (CT) scan using settings similar to those of conventional supine CT. The presence of a clinically significant PBS, defined as a brain shift of ≥ 5 mm caused by positional change, was evaluated. The clinical and radiological findings were investigated to identify factors associated with a larger PBS. As a result, twenty-one patients had a clinically significant PBS. The univariate analysis showed that supratentorial lesion location, intra-axial lesion type, craniectomy procedure, and residual intracranial air were the predictors of PBS. Based on the multivariate analysis, craniectomy procedure (p < 0.001) and residual intracranial air volume (p = 0.004) were the predictors of PBS. In a sub-analysis of post-craniectomy patients, PBS was larger in patients with supratentorial craniectomy site and parenchymal brain injury. A large craniectomy area and long interval from craniectomy were correlated with the extent of PBS. In conclusion, patients who undergo craniectomy and those with residual intracranial air can present with a large PBS. In post-craniectomy patients, the predisposing factors of a large PBS are supratentorial craniectomy, presence of parenchymal injury, large skull defect area, and long interval from craniectomy. These findings can contribute to safe mobilization among postneurosurgical patients and the risk assessment of sinking skin flap syndrome.


Assuntos
Lesões Encefálicas , Craniectomia Descompressiva , Pneumocefalia , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Lesões Encefálicas/etiologia , Craniotomia/efeitos adversos , Craniotomia/métodos , Craniectomia Descompressiva/efeitos adversos , Humanos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
7.
BMC Surg ; 22(1): 252, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35768812

RESUMO

BACKGROUND: Pneumocephalus may be responsible for post-craniotomy headache but is easily overlooked in the clinical situation. In the present study, the relationship between the amount of intracranial air and post-craniotomy headache was investigated. METHODS: A retrospective observational study was performed on 79 patients who underwent minimal invasive craniotomy for unruptured cerebral aneurysms. Those who had undergone previous neurosurgery, neurological deficit before and after surgery were excluded The amount of air in the cranial cavity was measured using brain computed tomography (CT) taken within 6 h after surgery. To measure the degree of pain due to intracranial air, daily and total analgesic administration amount were used as a pain index. Correlation between intracranial air volume and total consumption of analgesic during hospitalization was tested using Spearman rank correlation coefficients. Receiver operating characteristics (ROC) analysis was used to determine the amount of air associated with increased analgesic consumption over 72 h postoperatively. RESULTS: The mean amount of intracranial air was 15.6 ± 9.1 mL. Total administration of parenteral and oral analgesics frequency were 6.5 ± 4.5, 13.2 ± 7.9 respectively. A statically significant correlation was observed between daily and total parenteral analgesic consumption after surgery and the amount of intracranial air at followed-up brain CT postoperatively within 24 h (r = 0.69, p < 0.001), within 48 h (r = 0.68, p < 0.001), and total duration after surgery (r = 0.84, p < 0.001). The optimal cut-off value of 12.14 mL of intracranial air predicts the use of parenteral analgesics over 72 h after surgery. CONCLUSIONS: Pneumocephalus may be a causative factor for post-craniotomy pain and headache with surgical injuries.


Assuntos
Pneumocefalia , Analgésicos/uso terapêutico , Craniotomia/efeitos adversos , Cefaleia/etiologia , Humanos , Dor/complicações , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório
9.
Clin Exp Dent Res ; 8(3): 632-639, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35502527

RESUMO

BACKGROUND: A subcutaneous emphysema is an infrequent but potentially life-threatening complication after dental treatment involving instruments functioning with pressurized air. Emphysemata after the use of high-speed handpieces and air-syringes are well documented, however, more recently several reports on emphysemata produced by air-polishing devices during management of peri-implant biological complications have appeared. To the best of our knowledge, direct development of pneumocephalus after a dental procedure has never been reported before. Introduction of air likely contaminated with oral bacteria to the intracranial space bares the risk of developing meningitis. CASE PRESENTATION: This case report describes the spreading of a subcutaneous emphysema into the intracranial space (i.e., development of a pneumocephalus) after treatment of a peri-implantitis lesion with an air-polishing device equipped with the nozzle for submucosal debridement. A subcutaneous emphysema was noticed during the use of an air-polishing device and the subsequent computed tomography (CT) examination revealed a quite unexpected spreading of the emphysema into the intracranial space. The patient was admitted to the hospital for close surveillance, CT follow-up, and intravenous antibiotics to prevent the development of meningitis due to the introduction of air-likely contaminated with oral bacteria-into the intracranial space. After 3 days, the patient was discharged in good condition without any further complications. CONCLUSION: In case of an extensive subcutaneous emphysema as result of a dental procedure, a more extended radiographic examination including the mediastinal and cranial space should be considered, to assess the risk for potentially life-threatening complications.


Assuntos
Peri-Implantite , Pneumocefalia , Enfisema Subcutâneo , Desbridamento/efeitos adversos , Humanos , Peri-Implantite/etiologia , Peri-Implantite/cirurgia , Pneumocefalia/etiologia , Pneumocefalia/terapia , Enfisema Subcutâneo/complicações , Enfisema Subcutâneo/terapia , Tomografia Computadorizada por Raios X
11.
Turk Neurosurg ; 32(3): 449-458, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35147967

RESUMO

AIM: To examine the postoperative outcomes of electrode fixation using bone cement and Stimloc® in patients with Parkinson?s disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS). MATERIAL AND METHODS: Between 2016 and 2018, permanent electrode fixation was performed in 30 patients with PD, of which 15 received bone cement and the remaining 15 received Stimloc®. Data regarding preoperative Unified Parkinson?s Disease Rating Scale (UPDRS) III scores, levodopa equivalent daily dose (LEDD) values, surgery duration, and the fixation technique used were recorded. Brain computed tomography was performed for early postoperative evaluation of pneumocephalus and possible hematoma as well as for the determination of migration 1 year postoperatively. UPDRS III scores and LEDD values were re-evaluated 1 year postoperatively; surgery duration, clinical effectiveness, and complication rates were compared between the two fixation techniques. RESULTS: A statistically significant difference in application time was observed between the two techniques (bone cement: 21 min, Stimloc®: 6 min). After 1 year from surgery, 0.92- and 0.88-mm migrations were observed in the bone cement and Stimloc® groups, respectively. A significant correlation between migration and the pneumocephalus volume was observed in both groups. No differences were observed between the groups regarding infection, migration, pneumocephalus volume, wound erosion, and clinical outcomes. CONCLUSION: Stimloc® is preferred over bone cement for electrode fixation in DBS surgeries as it is associated with shorter application duration; this increases patient comfort and tolerance during awake surgery. Clinical efficacy and complication rates associated with both techniques are similar.


Assuntos
Neoplasias Encefálicas , Estimulação Encefálica Profunda , Doença de Parkinson , Pneumocefalia , Cimentos Ósseos/uso terapêutico , Neoplasias Encefálicas/complicações , Estimulação Encefálica Profunda/métodos , Eletrodos , Humanos , Levodopa , Doença de Parkinson/cirurgia , Pneumocefalia/complicações , Resultado do Tratamento , Vigília
12.
Oper Neurosurg (Hagerstown) ; 22(3): 158-164, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35166717

RESUMO

BACKGROUND: Robotic-assisted stereotactic systems for deep brain stimulation (DBS) have recently gained popularity because of their abilities to automate arduous human error-prone steps for lead implantation. Recent DBS literature focuses on frame-based robotic platforms, but little has been reported on frameless robotic approaches, specifically the Food and Drug Administration-approved Mazor Renaissance Guidance System (Mazor Robotics Ltd). OBJECTIVE: To present an initial case series for patients undergoing awake DBS with the Mazor Renaissance Guidance System and evaluate operative variables and stereotactic accuracy. METHODS: Retrospective data collection at a single institution was conducted for an initial 35 consecutive patients. Patient demographics and operative variables, including case times, microelectrode recording passes, and postoperative complications, were obtained by chart review. Implant accuracy was evaluated through measuring radial and vector (x, y) errors using the Mazor software. Pneumocephalus volumes were calculated using immediate postoperative T1-weighted MRI scans. RESULTS: Total operating room (245 ± 5.5 min) and procedural (179 ± 4.7) times were comparable with previous awake DBS literature. The radial error for center tract implants was 1.3 ± 0.1 mm, with smaller error in the first (1.1 ± 0.2) vs second (1.7 ± 0.3) implants of bilateral DBS (P = .048). Vector error analysis demonstrated larger shifts posteriorly for first implants and medially for second implants. Pneumocephalus volumes (12.4 ± 2.2 cm3) were not associated with increased microelectrode recording passes, radial error, or complications. CONCLUSION: Frameless robotic-assisted DBS is a safe and efficient new technology that has been easily adopted into the workflow at our institution.


Assuntos
Estimulação Encefálica Profunda , Pneumocefalia , Humanos , Imageamento Tridimensional , Microeletrodos , Estudos Retrospectivos , Estados Unidos
13.
J Craniofac Surg ; 33(3): 875-881, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35050560

RESUMO

OBJECTIVES: Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Concomitant rhinoliquorrhea and posttraumatic hydrocephalus (PTH) can complicate the clinical course. METHODS: The authors systematically reviewed pertinent articles published between 1961 and December 2020 and identified 6 patients with PTTP treated by EEA in 5 reports. Additionally, the authors share their institutional experience including a seventh patient, where an EEA resolved a recurrent PTTP without rhinoliquorrhea. RESULTS: Seven PTTP cases in which EEA was used as part of the treatment regime were included in this review. All cases presented with a defect in the anterior skull base, and 3 of them had concomitant rhinoliquorrhea. A transcranial approach was performed in 6/7 cases before EEA was considered to treat PTTP. In 4/7 cases, the PTTP resolved after the first intent; in 2/ 7 cases a second repair was necessary because of recurrent PTTP, 1 with and 1 without rhinoliquorrhea, and 1/7 case because of recurrent rhinoliquorrhea only. Overall, PTTP treated by EEA resolved with a mean radiological resolution time of 69 days (range 23-150 days), with no late recurrences. Only 1 patient developed a cerebrospinal fluid diversion infection probably related to a first incomplete EEA skull base defects repair. A permanent cerebrospinal fluid diversion was necessary in 3/7 cases. CONCLUSIONS: Endonasal endoscopic approach repair of air conduits is a safe and efficacious second-line approach after failed transcranial approaches for symptomatic PTTP. However, the strength of recommendation for EEA remains low until further evidence is presented.


Assuntos
Pneumocefalia , Endoscopia/efeitos adversos , Humanos , Nariz , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia
14.
J Int Med Res ; 50(1): 3000605221076032, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35086389

RESUMO

Tension pneumocephalus (TP) can be a life-threatening postoperative complication, but there are limited data owing to its exceedingly low frequency. A 48-year-old man that suffered a head injury survived the acute phase and cranioplasty was performed using a titanium plate. Progressive deterioration of consciousness occurred the day after the cranioplasty. Computed tomography showed the presence of expanded air in the left epidural cavity and a midline shift to the right side. Emergency skin flap reopening was performed. Tension of the scalp decreased when the skin suture was cut and the wound reopened. Lucidity and improved right hemiparesis were obtained within a few hours after drain insertion. Pooled air in the left epidural cavity gradually dissipated postoperatively and the epidural drain was removed 2 days after insertion. The patient was discharged 27 days after cranioplasty, with a modified Rankin scale score of 2. The mechanism that caused TP was considered. Specifically, the skin flap acted as a one-way valve and trapped air. Then the trapped air expanded as the patient's body temperature warmed. TP should be considered a differential diagnosis after craniotomy. Emergency skin flap reopening and drain insertion may be an effective treatment for TP in the epidural space.


Assuntos
Pneumocefalia , Titânio , Craniotomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Crânio , Retalhos Cirúrgicos
15.
Ear Nose Throat J ; 101(1): 15-19, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32543228

RESUMO

Pneumocephalus is usually induced by trauma, infections, tumors of the skull base, and surgical interventions. Spontaneous pneumocephalus occurs due to a defect in the temporal bone with no obvious cause. Few cases have been reported with spontaneous otogenic pneumocephalus. However, delayed postoperative pneumocephalus is rarely reported in the literature. Here, we present a case of otogenic pneumocephalus through Eustachian tube (ET) preceded by nose blowing 10 days after surgical treatment of meningoencephalocele of the right middle ear (ME) cleft and reconstruction of tegmen and dural defects. Pneumocephalus was provoked by decreased intracranial pressure (ICP) secondary to placement of lumbar drain, which caused direct communication between unsutured dural defect and the defective posterior wall of external auditory canal skin. A revision surgery of combined transmastoid/middle cranial fossa approach was performed for intracranial decompression followed by appropriate closure by suturing the dura, obliterating the ET and ME.


Assuntos
Orelha Média/cirurgia , Encefalocele/cirurgia , Otite Média Supurativa/cirurgia , Pneumocefalia/etiologia , Complicações Pós-Operatórias/etiologia , Osso Temporal/cirurgia , Tuba Auditiva , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/fisiologia , Reoperação , Osso Temporal/diagnóstico por imagem , Osso Temporal/patologia , Tomografia Computadorizada por Raios X
16.
World Neurosurg ; 158: e55-e63, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34656792

RESUMO

BACKGROUND: Depressed skull fracture is one of the most common neurosurgical emergencies in Ethiopia. The clinical outcome after surgical management and what factors predict the outcome are not well studied. Our study aimed to assess the outcome and identify predictors of the outcome in surgically treated adult patients. METHODS: A prospective, multicenter, observational study was undertaken on 197 cases, at 4 selected neurosurgical teaching hospitals in Ethiopia. Relevant data were collected and analyzed using Statistical Package for the Social Sciences software (IBM, Armonk, New York, USA). The outcome was assessed by the extended Glasgow Outcome Scale. Multivariate analysis was done to identify independent predictors of the outcome. RESULTS: The outcome was favorable in 81.2%. The mean age was 27. The mode of injury was violence in 79.7%. Motor deficit witnessed in 24.4%. Based on the Glasgow Coma Scale, 92.2% of patients had mild traumatic brain injury. Associated intracranial lesions were identified in 87.3%. The median hospital stay was 4.7 days. Reoperation and mortality rates were 4.1% and 0.5%, respectively. Five factors were statistically significant independent predictors of unfavorable outcome in multivariate analysis: motor deficit (adjusted odds ratio [AOR] 13.8, 95% confidence interval [CI]: 4.13-46.17, P = 0.000), Glasgow Coma Scale ≤13 (AOR 10.36, 95% CI: 1.93-55.56, P = 0.006), pneumocephalus (AOR 12.93, 95% CI: 3.12-53.52, P = 0.000), hospital stay for ≥3 days (AOR 4.39, 95% CI: 1.18-16.3, P = 0.027), and reoperation (AOR 6.92, 95% CI: 1.09-43.97, P = 0.04). CONCLUSIONS: The overall outcome was favorable. The presence of motor deficit, postresuscitation Glasgow Coma Scale ≤13, pneumocephalus, reoperation, and hospital stays for ≥3 days were independent predictors of an unfavorable outcome.


Assuntos
Pneumocefalia , Fratura do Crânio com Afundamento , Adulto , Etiópia/epidemiologia , Escala de Coma de Glasgow , Hospitais de Ensino , Humanos , Prognóstico , Estudos Prospectivos , Universidades
17.
J Craniofac Surg ; 33(1): 240-242, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34310424

RESUMO

ABSTRACT: Blow-out fracture is usually caused by direct traumatic events in the periorbital area. But in this case, the authors introduce a case in which the medial orbital wall was fractured directly through the medial rectus muscle by high pressure air gun.A 38-year-old man was injured in his right periorbital area after being hit by high pressure air gun. He had mild ecchymosis and subconjunctival hemorrhage. He had a normal light reflex and intraocular pressure of 14 mm Hg. A facial computed tomography scan confirmed a blow-out fracture of the medial orbital floor with multiple extensive subcutaneous emphysema in the right hemifacial area. Free air was also seen near the basal cistern and Sylvian fissure, indicating a pneumocephalus. The operation was performed after swelling and emphysema were subsided. Intraoperative, medial rectus muscle was damaged. After the operation, no abnormal findings were observed in the ophthalmic examination. Also, the free air findings, which were observed in preoperative x-ray, have disappeared.This case is a rare case in which an orbital wall has been fractured directly through the medial rectus muscle due to an air gun injury. Therefore, we should always kept in mind that blow-out fractures can occur even with unusual mechanisms.


Assuntos
Enfisema , Fraturas Orbitárias , Pneumocefalia , Adulto , Humanos , Masculino , Órbita , Fraturas Orbitárias/diagnóstico por imagem , Fraturas Orbitárias/etiologia , Fraturas Orbitárias/cirurgia , Espaço Subaracnóideo
18.
J Neurol Surg A Cent Eur Neurosurg ; 83(2): 206-209, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34261139

RESUMO

BACKGROUND: Pneumocephalus is a well-known complication in the surgical treatment of chronic subdural hematomas; however, its influence remains controversial. The amount of subdural air may vary, and it may cause worsening of symptoms, increase reoccurrence rates, and worsen the outcomes. Lethal outcome following acute onset of massive pneumocephalus was not previously reported. CASE REPORT: An 81-year-old man with bilateral hematomas underwent surgery under local anesthesia. Both hematomas were approached in the same surgery, and the drains were placed subdurally. After initial improvement, severe hypertension developed, followed by vital function and neurologic deterioration. Massive pneumocephalus with subarachnoid and contralateral intracerebral hemorrhage was revealed, causing a severe midsagittal shift. Emergency irrigation to evacuate subdural air was performed. However, there was no improvement. Further computed tomography confirmed subdural air collection, but it also revealed hemorrhage progression and intraventricular propagation. No further surgery was indicated. CONCLUSION: Pneumocephalus is an underestimated but potentially devastating complication. Both intraoperative avoidance and postoperative prevention should be utilized to avoid subdural air ingress, and thus evade potentially fatal complications.


Assuntos
Hematoma Subdural Crônico , Pneumocefalia , Idoso de 80 Anos ou mais , Doença Crônica , Drenagem/efeitos adversos , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
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