Pneumocephalus secondary to a spinal surgery: A literature review and a case report

Abstract

Introduction We report a case of pneumocephalus, which is identified as the presence of air in the cranial cavity and is a rare complication after spinal surgeries, in addition to a literature review of similarly reported cases. Case presentation The patient is a 63-year-old male who developed pneumocephalus after undergoing a minimally invasive left side decompression at L3-L4 with left L4 foraminotomy even though there were no signs of dural tears or Cerebrospinal Fluid (CSF) leaks. After the diagnosis of pneumocephalus using brain Magnetic Resonance Imaging (MRI), the patient was treated conservatively and was discharged after 3 weeks without developing further complications. Discussion Pneumocephalus is defined as an abnormal accumulation of air within the cranial cavity. It can occur due to a variety of causes but rarely due to gas forming bacteria. Many theories are suggested concerning the pathophysiology of pneumocephalus, the inverted bottle theory, the ball valve theory, the Nitrous Oxide (N 2 O) theory, and as we outweigh in our case, gas forming bacteria theory. Pneumocephalus can be treated surgically, nevertheless, conservative management methods of such cases are usually followed. Conclusion The aim of this study is to draw further attention to the management and diagnosis of such surgical complication. A more extended research is needed to provide a full comprehensive approach to deal with this problem if faced in the future. To the best of our knowledge, this study reports the first pneumocephalus case induced by a postoperative bacterial infection in the global English based medical literature.

Diffuse symptomatic pneumocephalus after biportal endoscopic spinal surgery: illustrative case

“…Most of the pneumocephalus after lumbar spine surgery could be explained by two major theories: 8 the inverted bottle theory and the ball valve theory. 9 , 10 The inverted bottle theory deduces that the negative pressure caused by CSF leakage is replaced by air until the intracranial pressure and extracranial pressure reach equilibrium.…”

Tension Pneumocephalus Unexpected Complication Following Lumbar Disc Surgery

“…2,4 Interventions frequently performed by physicians in the ED or many medical conditions they encountered may be complicated by PNC; air sinus fractures, chronic otitis media and sinusitis lumbar puncture and barotrauma. 2,5,6 In patients admitted to the ED in the early period after cranial or spinal surgery; PNC should be considered in the differential diagnosis if there is persistent headache, postoperative meningitis, post-surgical seizures abducens and oculomotor nerve palsy present. 1,2,7,8 Nowadays; lumbar disc surgery can be performed under both spinal anesthesia and general anesthesia.…”

“…2,5,6 In patients admitted to the ED in the early period after cranial or spinal surgery; PNC should be considered in the differential diagnosis if there is persistent headache, postoperative meningitis, post-surgical seizures abducens and oculomotor nerve palsy present. 1,2,7,8 Nowadays; lumbar disc surgery can be performed under both spinal anesthesia and general anesthesia. Each has possible disadvantages and advantages.…”

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Pneumocephalus (PNC) is an unusual but critical complication of epidural procedures and spine surgery only a few cases have been reported in the literature. 1,2 It is an abnormal presence of air in the cranium and usually caused by traumatic head injuries, infectious gas-forming bacteria, brain tumors, cranial surgeries, spontaneous autogenic factors, otorhinolaryngology procedures and diagnostic interventions such as lumbar puncture. 3 Magnetic resonance imaging can be definitive in the diagnosis but is less sensitive than computed tomography (CT) scans.

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“…CT imaging is the gold standard imaging technique for the diagnosis of PNC. 2 In this text; we present and discuss a case of PNC who presented to the emergency department (ED) with headache and change in mental status following lumbar disc surgery.…”