Symptomatic pneumocephalus: A rare complication of discal herniation's surgery

Abstract

Context We report the case of a 40-year-old woman with no pathological history, operated from an L4-L5 disc herniation by a left unilateral approach. The dura mater enveloping the left L5 root was accidentally injured at its lateral face causing a breach with CSF leakage. This breach could not be sutured. A few hours after waking, the patient presented an agitation followed by three generalized tonico-clonic seizures. Cerebral imaging revealed pneumocephalus. The patient was hospitalized in an intensive care unit. The symptoms gradually faded and the patient was discharged 3 days after surgery. Findings Pneumocephalus is defined by the presence of air inside the skull. The symptoms of pneumocephalus are generally non-specific and varied, and this complication should also be kept in mind to prevent potentially severe course. The prevention of postoperative pneumocephalus depends on a well-defined strategy in the case of iatrogenic dural tear. Conclusions Symptomatic pneumocephalus is a very rare complication in the course of lumbar surgery. Conservative therapy may be appropriate even in severe symptomatic manifestations.

Delayed pneumocephalus induced by repeated percutaneous aspiration after spinal surgery

“…Postoperative pneumocephalus is often caused by dural injury. [ 3 , 4 ] The presence of a dural injury was probably overlooked in our case.…”

“…[ 6 ] Hyperbaric oxygen therapy (set at 2.5 atmospheres, 110 minutes) may be a better choice to facilitate reabsorption of pneumocephalus. [ 14 ] Pneumocephalus usually resolves after several days [ 3 , 4 ] to several weeks. [ 7 , 10 ] When clinical symptoms such as intracranial hypertension and unconsciousness indicate a threat to life, urgent decompression should be considered to relieve intracranial hypertension.…”

“…Pneumocephalus of spinal origin may be associated with fractures caused by spinal trauma, [12] operative injury [3,4,7,8,10] Table 1, tumors, application of H 2 O 2 , [1,2] increased intraabdominal pressure, [6] or some diagnostic and therapeutic procedures, such as a lumbar puncture. Iatrogenic pneumocephalus [1][2][3][4]7,8,10,11] are not rare during spinal operation.…”

“…Consequently, surgeons face increasing numbers of dural tears and cerebrospinal fluid (CSF) leaks; CSF leakage secondary to a dural injury can cause pneumocephalus. [3,4] Most pneumocephalus occur within 1 to 3 days [4][5][6][7] after spinal surgery, and cases complicated by delayed pneumocephalus are rarely reported. However, there is a paucity of data on how to avoid the pneumocranium after spinal surgery.…”

Tension Pneumocephalus Unexpected Complication Following Lumbar Disc Surgery

“…Epidural injections are commonly practiced in the labor process and pain treatment. 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.…”