Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position

Sachkova, Alexandra; Schemmerling, Timm; Goldberg, Maria; Solomiichuk, Volodymyr; Rohde, Veit; Eckardstein, Kajetan L. von; Schatlo, Bawarjan

doi:10.1007/s00701-017-3444-1

Cited by 16 publications

(8 citation statements)

References 39 publications

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“…Tension pneumocephalus is known to occur after MVD surgery in the posterior fossa [21]. Tension pneumocephalus develops when air enters the intracranial cavity through a one-way valve.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative delirium in patients undergoing microvascular decompression

Cheng

et al. 2019

PLoS ONE

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This study is to identify the risk factors for postoperative delirium (PODE) in patients undergoing microvascular decompression (MVD) for the treatment of primary cranial nerve disorders. We retrospectively reviewed the data of 912 patients (354 men, 558 women) with primary cranial nerve disorders (trigeminal neuralgia, 602 patients; hemifacial spasm, 296 patients; glossopharyngeal neuralgia, 14 patients) who underwent MVD in the Neurosurgery Department of Lanzhou University Second Hospital between July 2007 and June 2018. Potential risk factors for PODE were identified using univariate and multivariate stepwise logistic regression analysis.Of the 912 patients, 221 (24.2%) patients developed PODE. Patients with PODE were significantly older and significantly more likely to be male than patients without PODE. A history of hypertension, preoperative carbamazepine therapy, and postoperative sleep disturbance and tension pneumocephalus were independently associated with PODE. Variables such as body-mass index, smoking and drinking habits, cardiac disease, diabetes mellitus, cerebrovascular disease, mean operative time, affected vessel, mean blood loss, postoperative intensive care unit stay, postoperative fever (>38°C), and routine laboratory results were not associated with PODE in our patients.PODE is a common complication after MVD, and is associated with multiple risk factors, including old age, male sex, hypertension, preoperative carbamazepine use, postoperative sleep disturbance, and tension pneumocephalus.

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“…Tension pneumocephalus is known to occur after MVD surgery in the posterior fossa [21]. Tension pneumocephalus develops when air enters the intracranial cavity through a one-way valve.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative delirium in patients undergoing microvascular decompression

Cheng

et al. 2019

PLoS ONE

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“…Pneumocephalus after PFS is mainly attributable to the “inverted pop bottle” mechanism in combination with an increased CSF loss [ 16 ]. In addition, patients’ age, duration of surgery, male gender, nitrous oxide (N 2 O) anesthesia and continuous CSF drainage via a lumbar drain are known risk factors [ 13 , 18 , 21 ]. Although pneumocephalus is common when surgery is performed in the SSP it is rarely symptomatic.…”

Section: Discussionmentioning

confidence: 99%

The semi-sitting position in patients with indwelling CSF shunts: perioperative management and avoidance of complications

et al. 2022

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Objective Posterior fossa or midline tumors are often associated with hydrocephalus and primary tumor removal with or without perioperative placement of an external ventricular drain (EVD) is commonly accepted as first-line treatment. Shunting prior to posterior fossa surgery (PFS) is mostly reserved for symptomatic cases or special circumstances. There are limited data regarding the anticipated risk for symptomatic pneumocephalus and the perioperative management using the semi-sitting position (SSP) in such a scenario. Here, we therefore assessed the safety of performing PFS in a consecutive series of patients over a period of 15 years to allow the elaboration of recommendations for perioperative management. Methods According to specific inclusion and exclusion criteria a total of 13 patients who underwent 17 operations was identified. Supratentorial pneumocephalus was evaluated with semiautomatic-volumetric segmentation. The volume of pneumocephalus was evaluated according to age and ventricular size. Results Ten of the 13 patients had a programmable valve (preoperative valve setting range 6–14 cmH20; mean 7.5 cmH20) while 3 patients had non programmable valves. A variable amount of supratentorial air collection was evident in all patients postoperatively (range 3.2–331 ml; mean 122.32 ml). Positive predictors for the volume of postoperative pneumocephalus were higher age and a preoperative Evans ratio > 0.3. In our series, we encountered no cases of tension pneumocephalus necessitating an air replacement procedure as well as no obstruction, disconnection, infection or hardware malfunction of the shunt system. Conclusions Our findings indicate that a CSF shunt in situ is not a contraindication for performing PFS in the semi-sitting position and it does not increase the pre-existing risk for postoperative tension pneumocephalus. In cases of primary shunting for hydrocephalus associated with posterior fossa tumors a programmable valve set at a medium opening pressure with a gravitational device is a valid option when PFS in the semi-sitting position is opted. In patients with an indwelling shunt diversion system special caution is indicated in order to prevent and detect overdrainage especially in not adjustable valves or shunts without antisiphon devices.

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“…Postoperative pneumocephalus was observed basically in all patients in our series. Since a ventricular tension pneumocephalus might require emergency EVD placement [ 18 ], we routinely implanted an EVD prior to tumor resection to manage the expected intraventricular air entrapment postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…VAE may occur in up to 38.6% [14] of surgeries depending on the measures used for its detection and its definition [1,5,6,12,13,15,16]. While the semi-sitting position has been abandoned in many centers because of its potential complications, there has been a renaissance, especially in European countries more recently [1,2,11,12,[17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Resection of posterior fossa tumors in the semi-sitting position in children younger than 4 years of age

et al. 2022

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Purpose The semi-sitting position for resection of posterior fossa tumors is a matter of ongoing debate. Here we report about our experience with this approach in children younger than 4 years of age. Methods We retrospectively analyzed data of children younger than 4 years of age operated on in our institution in the semi-sitting position over a 15-year period. Patients were intraoperatively monitored for venous air embolism (VAE) by transthoracic Doppler (TTD) or transesophageal echocardiography (TEE). The severity of VAE was classified according to the Tübingen grading scale. Intraoperative incidents of VAE were recorded and the patients’ course was followed postoperatively with a special focus on possible complications. Results Twenty-four children (18 boys, 6 girls) were operated on in the semi-sitting position (26 operations). Mean age was 2.2 years (± 1.0), range between 0.4 and 3.9 years. External ventricular drains were inserted in 18 children with hydrocephalus preoperatively. VAE was detected in 6 instances during surgery (6/26 (23.1%)). In 3 patients with grade 1 VAE, no additional treatment was necessary. In one patient with grade 2 VAE, intracardiac air suction via the central venous catheter was performed, and in two patients with grade 4 VAE, additional cathecholamine-infusion was administered. No major intraoperative complications occurred. Postoperative CT images showed pneumocephalus in all children. In two children, small asymptomatic impression skull fractures at the site of the Mayfield pin occurred. Revision surgery was necessary in one child with a suboccipital CSF fistula. Conclusion The semi-sitting position for resection of tumors in the posterior fossa in children younger than 4 years of age can be safely performed in experienced centers taking special caution to detect and treat potential complications in an interdisciplinary setting.

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Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position

Cited by 16 publications

References 39 publications

Risk factors for postoperative delirium in patients undergoing microvascular decompression

Risk factors for postoperative delirium in patients undergoing microvascular decompression

The semi-sitting position in patients with indwelling CSF shunts: perioperative management and avoidance of complications

Resection of posterior fossa tumors in the semi-sitting position in children younger than 4 years of age

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