Tension Pneumoventricle Secondary to Cutaneous-Ventricular Fistula: Case Report and Literature Review

Almubarak, Abdulaziz Oqalaa; Fakhroo, Fatima; Alhuthayl, Meshari; Kanaan, Imad; AlDahash, Homoud

doi:10.1016/j.wneu.2020.06.145

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…[ 6 ] In those patients who develop a CSF leak, the negative pressure inside the ventricles allows air to enter the ventricles. [ 1 , 3 , 5 , 17 ] For the treatment of pneumoventricle in patients with VP shunts, modification of the valve pressure may be sufficient for mildly symptomatic cases. [ 23 ] However, for significantly symptomatic patients, the placement of an EVD is usually required.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 , 10 , 13 , 19 ] Symptoms of tension pneumoventricle may include amnesia, headache, aphasia, mutism, gait deterioration, hearing loss, dementia, decline in mental status, agitation, delirium, seizures, focal neurological deficit, progressive loss of consciousness, dilation of pupils, and cardiac arrest. [ 1 , 5 , 11 - 13 , 15 , 16 , 18 - 21 , 24 ] Tension pneumoventricle is usually a neurosurgical emergency requiring urgent treatment. [ 1 , 5 , 8 , 10 ] The etiology should be adequately managed to prevent subsequent episodes.…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 , 5 , 11 - 13 , 15 , 16 , 18 - 21 , 24 ] Tension pneumoventricle is usually a neurosurgical emergency requiring urgent treatment. [ 1 , 5 , 8 , 10 ] The etiology should be adequately managed to prevent subsequent episodes.…”

Section: Introductionmentioning

confidence: 99%

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Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele

Jesús¹,

Thomas²,

Feliciano³

2022

Surgical Neurology International

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Background: Tension pneumoventricle is a rare, life-threatening complication. It has been rarely described in patients with ventriculoperitoneal (VP) shunts. Case Description: A 28-year-old male patient with a VP shunt became progressively lethargic after falling from his wheelchair. Skull X-rays and head CT scan showed abundant air inside the ventricles. He was taken to the operating room, and the shunt was revised without improvement. Two days later, a frontal external ventricular drain was placed to remove the air. In the investigation toward the etiology of the pneumoventricle, a review of previous head CT scans and brain MRIs showed that the patient had a small left frontonasal meningoencephalocele extending into the ethmoid, which had been unnoticed. He underwent repair of the defect with adequate sealing of the frontal skull base. Conclusion: In a shunted patient with moderate or severe symptoms from a tension pneumoventricle, external ventricular drainage is required to remove the air as the shunt is inadequate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele

Jesús¹,

Thomas²,

Feliciano³

2022

Surgical Neurology International

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“…[ 5 ] However, symptomatic PNC, better known as Tension PNC, is a life-threatening condition requiring urgent intervention due to the intracranial mass effect. [ 2 ] Tension PNC, although extremely rare, could be a severe complication of unintended dural puncture and injection of air inside the subarachnoid or the subdural spaces throughout the epidural anesthesia process. [ 10 ] Tension intraventricular PNC, on the other hand, is a rare type of intraventricular PNC.…”

Section: Introductionmentioning

confidence: 99%

Extensive tension pneumocephalus presented in the setting of a challenging etiology

Salih

Jaafer

Ismail

et al. 2022

Surgical Neurology International

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Background: Pneumocephalus (PNC) is a well-described consequence in postoperative settings and skull fractures that is usually self-limiting. It can get complicated into tension PNC on some rare occasions, leading to an intracranial mass effect. PNC was also reported after unintentional dural puncture throughout the epidural anesthesia process. However, tension PNC resulting from epidural anesthesia procedures is an extremely rare outcome that implies urgent intervention to relieve the tension within the brain. Here, we report a case of an extensive tension intraventricular PNC 2 days following an epidural anesthesia procedure for a femur fixation surgery. Case Description: A 23-year-old male presented to the emergency department with basal skull fractures and a femur fracture due to a motorcycle accident. His skull base fracture was managed conservatively then he underwent a femur fixation procedure under epidural anesthesia. Two days after, he developed a severe headache with a disturbed level of consciousness. Computed tomography of the brain revealed an extensive PNC that involved all the subarachnoid spaces down to the cervical region and compressing the cerebellum, which was not found in the initial imaging. The patient’s status improved after the twist-drill burr-hole evacuation of air under the water seal. Conclusion: Extensive tension PNC can occur after traumatic brain injury, especially after epidural anesthesia. Such cases should gain high focus because they may differ from simple PNC regarding diagnosis, treatment, and follow-up.

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“…As PV and ICP increase, the valve is occluded from above and the egress of air out of the ventricular system is obstructed. 4,5 Third infection by gasproducing organisms can lead to dPV. Once ambient air enters the ventricles, physical principles (Gay-Lussac law) result in its expansion as its temperature rises from the ambient temperature (20 to 24°C) to the internal body temperature (37.8°C).…”

Section: Discussionmentioning

confidence: 99%

Quadriparesis Due to Delayed Tension Pneumoventricle

Maramattom

2021

The Neurologist

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Introduction: Although pneumocephalus is very common after intracranial or spinal surgeries, pneumoventricle is uncommon. Tension pneumoventricle (tPV) occurs when air in the ventricles expands to cause neurological deficits or mass effect. It is usually seen with a combination of a ball-valve defect postoperatively that sucks in air and a ventriculoperitoneal shunt that drains cerebrospinal fluid and allows the ingress of air.Case Report: A young man developed delayed tPV after surgery for craniopharyngioma. He required multiple surgeries and occlusion of the ventriculoperitoneal shunt before the tPV resolved. Conclusions:The probable mechanisms of tPV and the importance of early recognition and treatment are discussed. A review of the literature of this uncommon entity has also been performed.

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Tension Pneumoventricle Secondary to Cutaneous-Ventricular Fistula: Case Report and Literature Review

Cited by 8 publications

References 25 publications

Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele

Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele

Extensive tension pneumocephalus presented in the setting of a challenging etiology

Quadriparesis Due to Delayed Tension Pneumoventricle

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