Tension Pneumocephalus: Fatal Complication of Nasal Surgery

Abstract

RESULTS: 145 cases of sinonasal hemangiopericytomas were identified. Mean age of diagnosis was 48.3 years old and there was equal prevalence of women and men. Primary tumor location was in the nasal cavity in 70% of cases. There were 38 (26%) recurrences following primary treatment, 6 tumor-related deaths and 2 cases of distant metastases. There was no significant difference between rate of recurrence based on type of primary surgical treatment (endoscopic vs. open resection)(pϭ0.07). CONCLUSION:The results of this study provide a better understanding of the prognosis of sinonasal hemangiopericytoma. Currently we have no evidence to suggest that open resection may be superior to endoscopic resection. Despite its low malignant potential, local recurrence is common and distant metastases are possible. Tension Pneumocephalus: Fatal Complication of Nasal SurgeryMohsen Naraghi, MD (presenter); Matin Ghazizadeh, MD; Massoud Boroojerdi, MD OBJECTIVE: Tension pneumocephalus is an uncommon and life-threatening complication of septoplasty and septorhinoplasty. Clinical features and management of two cases of tension pneumocephalus following nasal surgery are presented. METHOD:The first case was a 30-year-old man who was suffered from fever, intractable headaches, unilateral rhinorrhea, blurred vision, and confusion, with a history of septorhinoplasty one month ago. The second case was a 52-year-old afebrile man with headache, rhinorrhea, obtundation, and aphasia five days after a revision septoplasty. Lumbar puncture and cerebrospinal fluid analysis of both patients were indicative of bacterial meningitis. Imaging studies revealed some large air bubbles in the brain and bony defects in the skull base. RESULTS: Medical treatment of bacterial meningitis was executed for both patients. Thereafter, endoscopic repair of skull base was performed for the first case and no sign of recurrence was detected after two years. The second case underwent a neurosurgical operation to insert a drain into the air cavity to reduce the volume of air in the cranium and prepare him for repair. After operation, the level of consciousness decreased and he expired. CONCLUSION: Any unusual headache after septal surgery can herald a catastrophe, especially if other neurologic symptoms are present. The most important factors in the management of intracranial complications are prompt diagnosis and proper treatment. Gentle manipulation of the septum, considering anatomic variations of the skull base, is essential for prevention. The Role of Virus Infection in Chronic AdenoiditisJose Modena (presenter); Eurico Arruda; Edwin Tamashiro, MD, PhD; Fabiana Valera, MD, PhD OBJECTIVE: The role of virus in acute airway infections is well established. Nevertheless, their importance in chronic infections is still being discussed. Objectives: To identify the virus present in palatine and pharyngeal tonsils of patients submitted to adenotonsillectomy due to chronic tonsillitis, and to evaluate if there is any relationship between virus infection and tonsillar hyper...

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

“…TP following skull base surgery is a rare complication, previously reported to have only been reported in 33 cases in the literature, [1][2][3]6,7,14,15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] including this case (Table 1). Iatrogenic injury has been reported as a cause of TP during skull base surgery.…”

“…Clevens et al 18 Endoscopic nasal polypectomy and ethmoidectomy Recovery Iplikcioglu et al 19 Transphenoidal resection of Rathke's cleft cyst Recovery Yorgason et al 20 Transphenoidal resection of pituitary tumor Recovery Chou et al 21 Left nasal polypectomy and mucoperichondrial repair of CSF leak Recovery Ruiz-Juretschke et al 22 Transsphenoidal resection of pituitary adenoma Recovery Whitmore et al 23 Endoscopic sinus surgery Recovery Emmez et al 24 Endoscopic sinus surgery Recovery Pruss et al 25 Ethmoid sinus surgery Recovery Naraghi and Ghazizadeh 26 Septorhinoplasty Recovery Revision septoplasty Death Aksoy et al 14 Endoscopic sinus surgery Recovery Simmons and Luks 27 Endoscopic sinus surgery Permanent neurologic deficit Mammis et al 3 Endoscopic transplanum transtubercular approach for resection of a suprasellar epidermoid tumor…”