Pneumocephalus after posterior fossa exploration in the sitting position

Pandit, Uma A.; Mudge, Barbara J.; Keller, Ted S.; Samra, Satwant K.; Kilaru, Prasad; Pandit, Sujit K.; Cohen, Peter J.

doi:10.1111/j.1365-2044.1982.tb01711.x

Cited by 22 publications

(10 citation statements)

References 8 publications

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“…It was previously seen in posterior fossa surgery in sitting position. 6,7 Air enters cerebrospinal fluid (CSF) from dural site, with or without direct brain injury. 8,9 It can be serious if it turns into tension pneumocephalus.…”

Section: Discussionmentioning

confidence: 99%

Pneumocephalus Caused by an Epidural Ozone Injection for Treatment of Disc Prolapse

Rao¹,

Kotgire²,

Sastri³

2019

Res Pract Anesthesiol Open J

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Copyright 2019 by Rao SM. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited.Pneumocephalus is a complication seen either after head trauma or post-neurosurgical procedure. It can be life-threatening if it turns into tension pneumocephalus. The presence of intracranial air indicates the presence of an open communication of cerebrospinal fluid. Air enters dura matter even without connection. Thin air flows upstream along the cerebrospinal fluid (CSF) pathway. Herein, we report a case of pneumocephalus in a 62-year-old female after epidural injection of Bupivacaine and Ozone for the treatment of a prolapsed disc. She was shifted to our hospital post-epidural injection for the management of severe headache. Though it is a rare complication, keeping this in mind will help to quickly diagnose, if need arises.

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Section: Discussionmentioning

confidence: 99%

Pneumocephalus Caused by an Epidural Ozone Injection for Treatment of Disc Prolapse

Rao¹,

Kotgire²,

Sastri³

2019

Res Pract Anesthesiol Open J

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“…A slow infusion of normal saline through a subarachnoid catheter in the frontoparietal region during the surgical procedure may prevent the entrainment of air. [10]…”

Section: Discussionmentioning

confidence: 99%

Tension pneumoventricle after excision of third ventricular tumor in sitting position

Gupta

Rath

Mahajan

et al. 2011

J Anaesthesiol Clin Pharmacol

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Occurrence of tension pneumoventricle (symptomatic intraventricular air) can result in rapid clinical deterioration in an otherwise stable patient. It is a rare clinical entity, mentioned in relation to cerebrospinal fluid (CSF) diversion procedures, during the late postoperative period. We present a patient with posterior third ventricular tumor who underwent excision by midline suboccipital craniotomy in sitting position. Neurological status of the patient deteriorated rapidly in the immediate postoperative period owing to development of tension pneumoventricle. The condition improved after twist-drill burr-hole evacuation of air under water-seal. Pre-existing gross hydrocephalus, exploration of third ventricle in sitting position, and residual tumor in third ventricle were possibly the factors responsible for this complication.

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“…In some cases, it may be possible to reposition the head during the final moments of dural closure in such a way that brings the remaining dural defect to the highest point of the cranial cavity and facilitates the escape of remaining air while refilling the intradural space with irrigation fluid. Some authors have implied N 2 O in the pathogenesis of postsurgical pneumocephalus [30,35,36], whereas others have questioned its role [28,[37][38][39][40]. Presently, there is no evidence, including data from randomized clinical trials, to show that any particular anesthetic technique can either increase or decrease the amount of pneumocephalus after neurosurgical procedures [28,31,40].…”

Section: Prevention and Avoidance Of Contributing Factorsmentioning

confidence: 90%

Pneumocephalus: Case Illustrations and Review

2010

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Pneumocephalus is commonly encountered after neurosurgical procedures but can also be caused by craniofacial trauma and tumors of the skull base and rarely, can occur spontaneously. Contributing factors for the development of pneumocephalus include head position, duration of surgery, nitrous oxide (N(2)O) anesthesia, hydrocephalus, intraoperative osmotherapy, hyperventilation, spinal anesthesia, barotauma, continuous CSF drainage via lumbar drain, epidural anesthesia, infections, and neoplasms. Clinical presentation includes headaches, nausea and vomiting, seizures, dizziness, and depressed neurological status. In this article, we review the incidence, mechanisms, precipitating factors, diagnosis, and management of pneumocephalus. Search of Medline, databases, and manual review of article bibliographies. Considering four case illustrations that typify pneumocephalus in clinical practice, we discuss the common etiologies, and confirm the diagnosis with neuroimaging and management strategies. Avoidance of contributing factors, high index of suspicion, and confirmation with neuroimaging are important in attenuating mortality and morbidity. A significant amount of pneumocephalus can simulate a space-occupying lesion. Supplemental oxygen increases the rate of absorption of pneumocephalus.

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Pneumocephalus after posterior fossa exploration in the sitting position

Cited by 22 publications

References 8 publications

Pneumocephalus Caused by an Epidural Ozone Injection for Treatment of Disc Prolapse

Pneumocephalus Caused by an Epidural Ozone Injection for Treatment of Disc Prolapse

Tension pneumoventricle after excision of third ventricular tumor in sitting position

Pneumocephalus: Case Illustrations and Review

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