Symptomatic compressive pneumocephalus following lumbar decompression surgery

Abstract

We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2-L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, computed tomography was performed to explore intense lumbar pain and revealed a voluminous pneumorachis. Then, the patient experienced a generalized tonic-clonic seizure. Imaging revealed a voluminous pneumocephalus responsible for a significant space-occupying effect on the frontal lobe. A conservative treatment was initiated, including bed rest, oxygen therapy, neurological monitoring and anti-epileptic therapy. Symptoms gradually improved and he was discharged without any deficit after 10 days. A total radiological regression was noted in 21 days. Prevention of postoperative pneumocephalus should include a systematic repair of iatrogenic dural tear. Even in presence of severe symptomatic manifestations, a conservative treatment is possible.

Tension Pneumocephalus after Cervical Spine Surgery: A Case Report with Review of the Literature

“…Postoperatively, symptoms include a postural headache, nausea, vomiting, dizziness, and can be difficult to distinguish from common side effects of anesthesia. 7 17 A less immediate but serious sequelae of a dural tear is pneumocephalus, as in our case, and other serious complications include fistula formation, pseudomeningocele, meningitis, and epidural abscess. 17 The presenting symptoms of a pneumocephalus are typically nonspecific, such as lethargy, headache, nausea, vomiting, and confusion.…”

“…However, more concerning and severe symptoms of pneumocephalus include hemiparesis, seizures, and cranial nerve palsies. 1 2 7 …”

“…6 Patients who have sustained a tension pneumocephalus can present with headache, nausea, vomiting, photophobia, seizures, altered mental status, and decreased neurologic function. 1 2 7 …”

“…The first involves the “inverted bottle theory,” where cerebrospinal fluid (CSF) leaks out creating negative pressure in the subarachnoid space allowing air to enter. 6 7 8 9 10 The second theory is described as a “ball valve mechanism,” where a dural tear resulting from a fracture allows air to enter but cannot exit, similar to a tension pneumothorax. 6 7 8 9 10 …”

Pneumoencéfalo y pneumorraquis traumático: reporte de caso y revisión de la literatura

“…2) Mecanismo de la válvula de bola: el aire ingresa a la cavidad intracraneal por medio de un defecto cuando se excede la presión intracraneal por la presión extracraneal (maniobras de estornudo, tos y valsalva) 1,3,5,6,8,10,11 . Explicando el empeoramiento del pneumoencéfalo mediante ventilación no invasiva 12 . 3) Anestesia con óxido nitroso (N 2 O):…”