Postoperative Brain Stem Tension Pneumocephalus Causing Transient Locked-In Syndrome

Biyani, Naresh; Silbiger, A.; Ben‐Ari, Josef; Constantini, S.

doi:10.1159/000106394

Cited by 17 publications

(13 citation statements)

References 27 publications

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“…8 The clinical picture varies and a patient has been reported with locked-in-syndrome caused by pneumocephalus after resection of a recurrent astrocytoma. 9 In some patients the clinical picture is characterized by an overlap of akinetic mutism and parkinsonism. The latter has been observed particularly in pathologies such as supratentorial tumors sparing the basal ganglia, 10 subdural hematomas, 11,12 and hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Akinetic Mutism and Parkinsonism due to Subdural and Intraventricular Tension Pneumocephalus

Lütjens

Capelle

Krauss

2013

J Neurol Surg A Cent Eur Neurosurg

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Pneumocephalus may occur after intracranial surgery and is most often asymptomatic. It is usually associated with posterior fossa surgery. Here, we present a 56-year-old man who developed akinetic mutism and parkinsonism caused by subdural and intraventricular tension pneumocephalus associated with decompression of a chronic subdural hygroma. As an emergency treatment, air was exchanged with saline via the drainage, which then was removed and a subduro-peritoneal shunt was implanted. The condition described here requires immediate attention and appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Akinetic Mutism and Parkinsonism due to Subdural and Intraventricular Tension Pneumocephalus

Lütjens

Capelle

Krauss

2013

J Neurol Surg A Cent Eur Neurosurg

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“…However, compression of intracranial structures by the transformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare [4] . This complication is widely reported in the follows of a posterior fossa surgery performed in the sitting position [3] , [5] . The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is very rare [6] .…”

Section: Introductionmentioning

confidence: 92%

“…The term encompasses gas in any of the intracranial compartments, and is most commonly encountered following trauma or surgery [1] . Pneumocephalus after supratentorial craniotomy is very common, reported in almost 100% of the patients [2] , [3] . However, compression of intracranial structures by the transformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare [4] .…”

Section: Introductionmentioning

confidence: 99%

Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

Gader

Rkhami

Daghfous

et al. 2022

International Journal of Surgery Case Reports

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Introduction The term pneumocephalus refers to the existence of air in any intracranial compartment. Its presence in the follows of a supratentorial craniotomy is very common, and it usually represents a benign complication as it is very rarely responsible for clinical manifestations. Case presentation We report the case of a 24 years-old man, who underwent posterior fossa surgery in prone position for resection of a vermian tumor. Postoperative, the patient presented a tonic-clonic generalized seizure associated to high levels of arterial pressure and decerebration. Control CT scan showed an important pneumocephalus. On the posterior fossa, the air was responsible for a compression of the brainstem, without any other postoperative complications. Following 12 h of conservative management, a brain MRI showed a total regression of the pneumocephalus. 3 days later, the patient presented a favorable outcome as he was extubated without any major impairments. Discussion Transformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare. This complication is mainly related to surgeries performed in sitting position. The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is seldom. Conclusions Through this case, we discuss pathophysiology and therapeutic approaches for tension pneumocephalus following posterior fossa performed in prone position.

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“…Furthermore, administration of dehydrating agents (e.g. mannitol, furosemid), use of nitrous oxide (N 2 O), hyperventilation, removal of a space-occupying mass, cerebral hemorrhage-associated vasoconstriction, drainage of CSF, and the gravitational effect contribute to the development of pneumocephalus [ 9 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Normobaric Hyperoxia for Treatment of Pneumocephalus after Posterior Fossa Surgery in the Semisitting Position: A Prospective Randomized Controlled Trial

et al. 2015

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BackgroundSupratentorial pneumocephalus after posterior fossa surgery in the semisitting position may lead to decreased alertness and other symptoms. We here aimed to prove the efficacy of normobaric hyperoxia on the absorption of postoperative pneumocephalus according to a standardized treatment protocol.Methods and FindingsWe enrolled 44 patients with postoperative supratentorial pneumocephalus (> 30 ml) after posterior fossa surgery in a semisitting position. After randomisation procedure, patients received either normobaric hyperoxia at FiO2 100% over an endotracheal tube for 3 hours (treatment arm) or room air (control arm). Routine cranial CT scans were performed immediately (CT1) and 24 hours (CT2) after completion of surgery and were rated without knowledge of the therapy arm. Two co-primary endpoints were assessed: (i) mean change of pneumocephalus volume, and (ii) air resorption rate in 24 hours. Secondary endpoints were subjective alertness (Stanford Sleepiness Scale) postoperatively and attention (Stroop test), which were evaluated preoperatively and 24 hours after surgery. The mean change in pneumocephalus volume was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.001). The air resorption rate was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.0015). Differences were more pronounced in patients aged 52 years and older. No difference between patients in treatment arm and control arm was observed for the Stroop test. The distribution of scores in the Stanford Sleepiness Scale differed in the treatment arm as compared to the control arm, and there was a difference in mean values (p = 0.015).ConclusionsAdministration of normobaric hyperoxia at FiO2 100% via an endotracheal tube for 3 hours is safe and efficacious in the treatment of pneumocephalus after posterior fossa surgery in the semisitting position. Largest benefit was found in elderly patients and particularly in older men.Trial RegistrationGerman Clinical Trials Register DRKS00006273

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Postoperative Brain Stem Tension Pneumocephalus Causing Transient Locked-In Syndrome

Cited by 17 publications

References 27 publications

Akinetic Mutism and Parkinsonism due to Subdural and Intraventricular Tension Pneumocephalus

Akinetic Mutism and Parkinsonism due to Subdural and Intraventricular Tension Pneumocephalus

Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?

Normobaric Hyperoxia for Treatment of Pneumocephalus after Posterior Fossa Surgery in the Semisitting Position: A Prospective Randomized Controlled Trial

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