Neumoencéfalo y fístula de líquido cefalorraquídeo tras resección de tumor del sulcus superior (tumor de Pancoast)

An unusual cause of acute headache: subarachnoid free air secondary to spontaneous bronchopleurodurosubarachnoid fistula from a Pancoast tumor

“…Sequential CT and MR imaging of the craniospinal axis was diagnostic in this case. When the source of the fistula is not clear, CT or radioisotope cisternomyelography may assist in diagnosis [4], [7], [10].…”

“…Approximately 50% of the reported perioperative cases of fistulas had received neoadjuvant radiation therapy [7]. Only 2 case reports show bronchopleurodurosubarachnoid fistula formation without preceding surgery; both fistulas happened after radiation therapy [5], [9].…”

“…A rare cause is bronchopleurodurosubarachnoid fistula, an unusual and difficult clinical problem with limited case reports, commonly related to trauma or posterolateral thoracotomies [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. We present a case of symptomatic pneumocephalus and pneumorrhachis caused by spontaneous nonsurgical, nontraumatic bronchopleurodurosubarachnoid fistula from a Pancoast tumor invading the spine after palliative chemoradiation.…”

Pneumocephalus Following Thoracic Surgery with Posterior Chest Wall Resection

“…The body of literature is limited to a few articles after thoracic surgery. 1 2 Symptoms such as headache, vertigo, nausea, vomiting, disorientation, and convulsion are described and may be a complication of meningitis due to pleuro-subarachnoid fistulas. Nevertheless, it was discussed whether pleuro-subarachnoid fistulas are often not recognized in the postoperative course.…”

“…In our case, the patient developed first symptoms on the first postoperative day, while other authors describe first symptoms between 1 and 8 wk after operation. 1 2 3 4 5 Most reported cases of pneumocephalus developed after removal of the chest tube when intrapleural air extends under positive pressure into the subarachnoid space. 2 Dural tear during rib resections at the costovertebral junction or around the intercostal nerve root facilitates pleuro-subarachnoid fistulas.…”