The Incidence of Pneumocephalus after Supratentorial Craniotomy

Lumbar epidural anesthesia is commonly used for labor analgesia. The 'loss-of- resistance' to air technique (LORA) is generally employed for recognition of the epidural space. One of the rare complications of this technique is pneumocephalus (PC). Here we describe the case of a parturient who developed a frontal headache when locating the epidural space using LORA. On the second day after epidural injection, the patient exhibited occipital headaches with gradual worsening. Computed tomography scans of the brain indicated PC. Following symptomatic treatment, our patient was discharged on the 13th day. We concluded that the amount of air used to identify the epidural space in LORA should be minimized, LORA should not be used after dural puncture and the use of saline avoids PC complications.

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“…PC is relatively common in neurosurgery 7 and neuroradiology 8, 9 . It can be caused by trauma 10 or infections 11, 12 .…”

Section: Discussionmentioning

confidence: 99%

Case Report: Pneumocephalus after labor epidural anesthesia

Nistal-Nuño

Gómez-Ríos

2014

F1000Res

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“…The amount of intracranial air varies, but it is usually benign in nature, requiring approximately 2–3 weeks for complete reabsorption [1, 2]. Reasoner et al[ 2] documented postoperative intracranial air in all cases of supratentorial craniotomy. The air is eventually reabsorbed over the course of about 4 weeks postoperatively, with the average incidence decreasing by approximately 25% per week.…”

Section: Discussionmentioning

confidence: 99%

“…Although most instances of postoperative pneumocephalus are asymptomatic and gradually resolve, cases of a supratentorial tension pneumocephalus (symptomatic pneumocephalus) requiring treatment have been reported [1, 2]. Most instances of tension pneumocephalus are reported after posterior fossa surgery in the sitting position [4,5,6,7,8].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Brain Stem Tension Pneumocephalus Causing Transient Locked-In Syndrome

Biyani

Silbiger²,

Ben‐Ari³

et al. 2007

Pediatr Neurosurg

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The incidence of pneumocephalus after supratentorial craniotomy has been reported to be as high as 100%. However, transformation of postoperative pneumocephalus into tension pneumocephalus (symptomatic intracranial air) is a rather rare phenomenon. Tension pneumocephalus after posterior fossa surgery is reported mainly when the surgery is performed in a sitting position. We hereby report on a patient who developed brain-stem tension pneumocephalus in the early postoperative period after posterior fossa craniotomy for an exophytic brainstem astrocytoma, operated in the prone position. A complete locked-in syndrome resolved following surgical relief of the trapped air.

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“…A wide range of neurosurgical conditions and procedures have been implicated; the mechanisms of causation are also varied. All patients who have had craniotomy or craniectomy will have detectable air in the cranium within the first week of surgery; subsequently the incidence decreases [4]. The quantity of air is usually small and is asymptomatic, requiring no treatment.…”

Section: Discussionmentioning

confidence: 99%