Tension Pneumocephalus Following Surgery for Subdural Hematoma

Bouzarth, William F.; Hash, Cecil J.; Lindermuth, John R.

doi:10.1097/00005373-198006000-00004

Cited by 19 publications

(19 citation statements)

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“…While Toung et al . [19] treated their TP patient by craniostomy, Bouzarth[4] described percutaneous catheter connected to negative pressure for release of TP. Cummins used indwelling drain catheter to aspirate the air and relieve TP in his patient.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

Shaikh

Masood²,

Hanssens³

et al. 2010

Surg Neurol Int

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Background:Pneumocephalus is the presence of air in the cranial cavity. When this intracranial air causes increased intracranial pressure and leads to neurological deterioration, it is known as tension pneumocephalus (TP). TP can be a major life-threatening postoperative complication, especially after evacuation of chronic subdural hematoma. We report a case of TP after evacuation of chronic subdural hematoma and review the literature.Case Description:A 70-year-old man developed right-sided weakness after being admitted with minor head trauma a few weeks earlier. He was found to have a chronic subdural hematoma and underwent burr-hole evacuation. On day 3, he suddenly deteriorated and needed intubation and ventilation. Computerized tomography (CT) of the brain showed typical Mount Fuji’s sign due to TP. Immediately, 20-30 mL of air was aspirated from the intracranial fossa, and a catheter drain was inserted. The patient became fully awake after few hours and was extubated successfully. The drain was removed on day 5, and he was transferred to the ward before being discharged home.Conclusion:TP after evacuation of a chronic subdural hematoma is a neurosurgical emergency and needs immediate resuscitation and therapy; hence it is of vital importance that all acute-care physicians, intensivists and neurosurgeons be aware of this clinical emergency.

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Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

Shaikh

Masood²,

Hanssens³

et al. 2010

Surg Neurol Int

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“…Other causes are tumours (13%), including those of the paranasal sinuses [2], infection (9%) and previous surgery (4%) [1,3]. Rare causes include complications associated with spinal and epidural anaesthesia and the use of continuous airway pressure after trauma [4].…”

Section: Discussionmentioning

confidence: 99%

“…Rare causes include complications associated with spinal and epidural anaesthesia and the use of continuous airway pressure after trauma [4]. Tension pneumocephalus indicates that there is clinical deterioration due to increasing intracranial pressure [3].…”

Section: Discussionmentioning

confidence: 99%

Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula.

Lin

Cheah²,

Ng³

et al. 2000

The British Journal of Radiology

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“…If intracranial air is present post-operatively [1, 2], for example after the surgical evacuation of an intracranial expansive lesion, it will also be resorbed over time, over weeks [3, 4]. In modern, centralized, specialty care, patients receiving neurosurgical operative interventions (commonly borr hole or mini-craniotomy) at a tertiary care hospital may be transported back to their home hospital early after their operation accompanied by critical care personnel [5, 6], where post-operative intracranial air (if present) has not yet been resorbed.…”

Section: Introductionmentioning

confidence: 99%

Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation

Brändström

Sundelin

Hoseason

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundPost-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures.MethodsA cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations.ResultsApproximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during ‘flight’ would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop ‘inflight’ related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile.DiscussionThese findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport.ConclusionsVery small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

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Tension Pneumocephalus Following Surgery for Subdural Hematoma

Cited by 19 publications

References 0 publications

Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula.

Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation

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