Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Pneumocephalus”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1986

Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study.

Thirty patients subjected to posterior fossa surgery in the sitting position were evaluated postoperatively by CT scans in order to assess the true incidence of pneumocephalus and subsequent development, if any, of tension pneumocephalus. This prospective survey shows that the postoperative incidence of intracranial air was 100%, while no progression towards tension pneumocephalus producing severe neurological deterioration was observed. It can thus be claimed that, although the sitting position may favour the development of tension pneumocephalus also other factors contribute to its pathogenesis. Finally, neither nitrous oxide nor temperature play any significant role in the development of this complication.

Adolescent↗
PubMed1983

Tension pneumocephalus after posterior fossa craniotomy: report of four additional cases and review of postoperative pneumocephalus.

Four cases of tension pneumocephalus after either posterior fossa craniotomy or translabyrinthine resection of acoustic neuroma with or without nitrous oxide anesthesia are described. Three of the operations were performed with the patient in the sitting position, and one was done with the patient in the lateral position. Of the three cases operated in the sitting position, no nitrous oxide was used at any time during anesthesia in one. Two patients failed to regain consciousness after the termination of anesthesia, and the other two developed the sudden onset of neurological symptoms 1 to 1.5 hours after the operation. In all cases computed tomography disclosed a large subdural collection of air. Re-exploration of the surgical wound or twist drill aspiration of the subdural air resulted in prompt recovery of neurological status in three patients, whereas the other patient's neurological status improved gradually without any specific treatment. The role played by nitrous oxide, the mechanisms by which air enters the intracranial space, the contributory factors, and the predisposing surgical conditions of tension pneumocephalus are reviewed and discussed. Dependent drainage of the cerebrospinal fluid, especially in a patient with coexisting hydrocephalus, seems to be the most important factor for the development of this complication.

Aged↗
PubMed1994

Incidence and perioperative management of tension pneumocephalus following craniofacial resection.

This study is a retrospective review to evaluate factors associated with the risk of pneumocephalus following craniofacial resection and the management of tension pneumocephalus. Twenty-two craniofacial operative procedures were reviewed in 18 patients entered into the Neurosciences Critical Care Unit, Johns Hopkins Hospital, during a 54 month period, from 1986-1991. Pneumocephalus developed after 7 of 22 operations; of these seven, two developed tension pneumocephalus. The use of lumbar cerebral spinal fluid (CSF) drainage during the operation correlated most strongly with the development of pneumocephalus. The diagnosis of esthesioblastoma also correlated significantly. Both episodes of tension pneumocephalus occurred after craniofacial resection in which lumbar drainage of CSF was performed. Tension pneumocephalus was successfully treated in these two patients with a combination of air evacuation and medical management of raised intracranial pressure. Transient diabetes insipidus developed in both patients. The risk of pneumocephalus following craniofacial procedures is significant, and may be increased by the use of lumbar drainage of CSF intraoperatively. Rapid neurologic deterioration following craniofacial resection may be caused by the development of tension pneumocephalus. Early diagnosis of tension pneumocephalus and aggressive management of raised intracranial pressure may be important in preventing serious neurological complications.

Adult↗
PubMed1994

The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air.

BACKGROUND: Pneumocephalus occurs in a variety of clinical settings and has important anesthetic implications, particularly if N2O is used. One common cause of pneumocephalus is a craniotomy or craniectomy, and therefore, patients undergoing these neurosurgical procedures may be at increased risk for the development of tension pneumocephalus if N2O is used during a subsequent anesthetic. However, because the rate at which a postoperative pneumocephalus resolves has not been well defined, the duration of this risk period is unknown. METHODS: Department of Anesthesia billing codes were used to identify all patients undergoing supratentorial craniotomy between 1986 and 1990. This list was cross-indexed with Department of Radiology data to generate a list of patients who had had a computed tomographic scan of the head performed on or after the day of their surgery. From this list, 240 scans were examined for the presence of intracranial air. The magnitude of pneumocephalus, if present, was ranked as large, moderate, small, or trace. RESULTS: Air was seen in all scans obtained in the first 2 post-operative days. Sixty-six percent of these pneumocephali were judged to be moderate or large. The incidence of pneumocephalus decreased to 75% by postoperative day 7. During the 2nd and 3rd postoperative weeks, the incidence of pneumocephalus decreased to 59.6 and 26.3%, respectively. The size of the pneumocephali also decreased. Still, 11.8% of the scans obtained during the 2nd postoperative week had pneumocephali that were judged to be moderate or large. CONCLUSIONS: These data indicate that all patients have pneumocephalus immediately after a supratentorial craniotomy. Although the incidence and size of pneumocephali decrease over time, a significant number of patients have an intracranial air collection large enough to put them at risk for complication if N2O is used during a second anesthetic in the first 3 weeks after the first procedure. This information should be considered in the evaluation of the patient and in the selection of anesthetic agents.

Anesthesia, General↗
PubMed1986

Pneumocephalus: effects of patient position on the incidence and location of aerocele after posterior fossa and upper cervical cord surgery.

The incidence of pneumocephalus and factors contributing to its occurrence were studied retrospectively in 100 consecutive patients who underwent posterior fossa or cervical cord surgery in the sitting, park-bench, and prone positions. Supine skull x-ray films taken immediately postoperatively were used to determine the presence of intracranial air. Surgery in the sitting position uniformly resulted in pneumocephalus (32/32 patients). Pneumocephalus also occurred frequently among patients in the park-bench (29/40) and prone positions (16/28). Intraventricular air occurred more frequently when patients were in the sitting position (25/32) than in the two other surgical positions (3/29 and 4/16, respectively, P less than 0.001). The high incidence of pneumocephalus and of intraventricular air that occurred when patients were in the sitting position is attributed to the large amount of cerebrospinal fluid drained due to gravitational effect. When surgical position is considered one of the contributing factors, only positions significantly affected the frequencies of pneumocephalus and intraventricular air accumulation. None of the 77 patients with pneumocephalus suffered neurologic change related to the presence of intracranial air. We conclude the following: pneumocephalus commonly occurs after posterior fossa or cervical cord surgeries, particularly when the surgery is performed in the sitting position; neurologic change caused by pneumocephalus is a rare complication after posterior fossa craniotomy; when a patient with coexisting hydrocephalus undergoes surgery, if the patient is in the sitting position, there is an increased risk of trapping a large amount of intracranial air.

Adolescent↗
PubMed1997

Symptomatic pneumocephalus after transsphenoidal surgery.

BACKGROUND: Symptomatic pneumocephalus after transsphenoidal surgery, though reported, is a rare phenomenon. We report three cases of pneumocephalus in a series of 300 transsphenoidal operations for sellar/suprasellar mass lesions done over the past 12 years. METHODS AND RESULTS: Three cases of symptomatic pneumocephalus occurring after transsphenoidal surgery are presented to illustrate the causative factors, methods of prevention, and management. In case 1, an intraoperative cerebrospinal fluid (CSF) leak occurred and drainage of CSF through a lumbar subarachnoid drain resulted in pneumocephalus, in spite of repair of the sellar floor. In case 2, partial excision of tumor and subsequent reduction of intracranial pressure due to a ventriculoperitoneal (VP) shunt led to pneumocephalus. In case 3, radiotherapy-induced shrinkage of a partially excised tumor resulted in pneumocephalus. The sellar floor had not been repaired in cases 2 and 3 as there was no intraoperative CSF leak and only a partial excision had been done. Conservative management failed in the two patients in whom it was tried. Repair of the sella and sphenoid sinus had to be done in all three cases. CONCLUSIONS: Repair of the sellar floor should be done after a transphenoidal approach in all cases, even when no intraoperative leak has been identified and only a partial excision of tumor has been done. Once pneumocephalus has occurred, the sellar floor and sphenoid sinus should be repaired early before reducing the intracranial pressure (ICP) by tapping ventricular air and draining or diverting CSF.

Brain Neoplasms↗
PubMedDate not supplied

Tension pneumocephalus following craniofacial resection.

BACKGROUND: The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are well-known complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus. METHODS: Case study. We reviewed the records of all patients who underwent anterior craniofacial resection at our institution, a tertiary care center, from 1976 to 1993. Among 45 patients identified, 2 had tension pneumocephalus. RESULTS: Neurologic deterioration after anterior craniofacial resection occurred in both patients in the immediate postoperative period. Both patients had extradural intracranial air under pressure and were diagnosed with tension pneumocephalus. In one patient, this was treated by needle aspiration followed by catheter drainage, and the second patient was treated with needle aspiration followed by airway diversion. The first patient recovered fully and was discharged on postoperative day 14; the second patient's mental status did not return to the preoperative level, and he was discharged on postoperative day 23 to a rehabilitative facility. Approximately 3 months later, his level of mentation returned to baseline. CONCLUSIONS: Tension pneumocephalus is a potentially devastating complication that may occur after craniofacial resection. It requires prompt recognition and treatment to minimize morbidity.

Adenocarcinoma↗
PubMed1998

Traumatic subdural pneumocephalus causing rise in intracranial pressure in the early phase of head trauma: report of two cases.

This paper presents two unique cases of subdural tension pneumocephalus which has deteriorated in the early phase of head trauma. Subdural pneumocephalus accounts for about 25% of all intracranial pneumocephalus cases. In the literature subdural pneumocephalus is describes as a benign and spontaneously resolving condition. Contrary to the available literature and our experience in 1341 trauma cases in the past ten years of whom 76 had subdural pneumocephalus, both cases deteriorated in the early hours following head trauma due to an increase in subdural air volume which was evacuated by craniotomy.

Adolescent↗
PubMed1999

An unusual fatal complication of low basilar trunk aneurysm surgery: isolated prepontine tension pneumocephalus.

OBJECTIVE: A case of postoperative tension pneumocephalus after low basilar trunk aneurysm clipping is presented. To our knowledge, this is the first case of isolated prepontine tension pneumocephalus. BACKGROUND: A 63-year-old woman was admitted for repair of a basilar aneurysm that had caused a subarachnoid hemorrhage. She was cooperative and partially oriented. According to Hunt & Hess classification, she was considered Grade III. METHOD: The aneurysm was clipped, using a right lateral suboccipital craniectomy with the patient in the sitting position. In the early postoperative period, she had no new neurological deficit. However, 2 hours later the patient became lethargic and unresponsive to verbal commands. Emergency CT scan revealed an isolated prepontine tension pneumocephalus with prominent posterior displacement of the pons. She was immediately taken back to surgery. Upon incision of the dura mater, air could be heard escaping under pressure from the posterior fossa cavity. The clip was in its proper position and all arteries were patent. Spontaneous respiration and pupil reflexes returned soon after surgery, but she remained unconscious and died 3 days later. CONCLUSION: We believe that this death was directly attributable to the tension pneumocephalus and the distortion of the pons. Postoperative prepontine tension pneumocephalus, although this is an extremely rare condition, should be considered if a patient deteriorates after basilar aneurysm surgery in the sitting position.

Basilar Artery↗
PubMed1995

Tension pneumocephalus--a rare complication of radiotherapy in nasopharyngeal carcinoma.

A patient with nasopharyngeal carcinoma (NPC) treated by radiotherapy developed tension pneumocephalus due to a naso-cranial fistula. The fistula was due to a pathological fracture at the base of skull affected by bone necrosis. The clinical features, neuro-radiological and post-mortem findings are presented. This is the first case report of pneumocephalus in association with NPC. The brain showed florid subarachnoid and intraventricular air collection under tension, low grade meningitis, foreign body giant cell reaction in the arachnoid membrane and multifocal cerebral infarction. Late radiation necrosis was also found in the left temporal lobe. The cause of the tension pneumocephalus in relation to radiation bone necrosis and the possible role of pneumocephalus in producing the multifocal cerebral infarction are discussed. The more common radiation necrosis of brain is also discussed. The pathogenesis of the pneumocephalus in this patient is distinctly different from the more common causes such as head injury and surgery.

Aged↗
PubMed2001

Pneumocephalus secondary to a neck stab wound without neurologic injury in a 13-year-old girl.

Pneumocephalus is usually caused by injury that damages the brain meninges and thus allows air to enter the intracranial cavity. Our intention was to establish the importance of considering a stab wound in the neck as a possible cause of traumatic pneumocephalus. The paper presents the case of a 13-year-old girl who was accidentally stabbed in the neck with a kitchen knife by her brother. She had no neurological deficit but had developed headaches. An examination showed cerebrospinal fluid leaking from the neck wound and a CT scan revealed the pneumocephalus. Following surgical treatment, the patient's clinical symptoms regressed. To our knowledge, this case is the first report of the manifestation of pneumocephalus as the result of a neck stab wound in a child; overall, there are only three reported cases of pneumocephalus caused by a neck stab wound.

Adolescent↗
PubMed1986

Otogenic pneumocephalus.

Fifty-four previously reported cases of otogenic pneumocephalus were analyzed in addition to five new cases which are presented in detail. Forty-one males and 18 females were included with 95% of the patients being over 12 years of age. The most common presenting symptom was headache, and the ventricular system was the intracranial space most commonly involved. Tension pneumocephalus was present in 40 (66%) cases. Trauma (36%) was the most common etiologic factor, while otitis media (30%), otologic surgery (30%), and congenital defects (2%) accounted for the rest. The overall mortality was 12% with all patients succumbing to causes other than pneumocephalus. Because of its lack of specific symptoms, pneumocephalus was usually unsuspected and the diagnosis made only after radiographic evaluation. Despite its rarity, pneumocephalus has to be considered whenever the dura is violated, especially if associated with a CSF leak. Management depends on the degree of tension, symptomatology, and underlying cause. When associated with trauma or surgery, bedrest and close monitoring may suffice, although needle aspiration or re-exploration may be needed. When secondary to otitis media or a congenital defect, control of any infection and repair of the defect are mandatory.

Adolescent↗
PubMed1988

Subdural tension pneumocephalus following surgery for chronic subdural hematoma.

The computerized tomography (CT) findings were analyzed in five cases of subdural tension pneumocephalus following surgery for chronic subdural hematoma. They were compared with CT scans in 14 cases of asymptomatic subdural pneumocephalus. In this study, two new CT findings were identified that suggest increased tension of the subdural air. Subdural air separates and compresses the frontal lobes, creating a widened interhemispheric space between the tips of the frontal lobes that mimics the silhouette of Mt. Fuji. The presence of air between the frontal tips associated with massive air inclusion over the frontal lobes presumably indicates increased tension of the subdural air. The "Mt. Fuji sign" was seen in four of the five cases with subdural tension pneumocephalus. The other finding was the presence of multiple small air bubbles scattered through several cisterns ("air bubble sign"). It is postulated that these air bubbles enter the subarachnoid space through a tear in the arachnoid membrane caused by increased tension of air in the subdural space. This finding was seen in four cases with subdural tension pneumocephalus. These two CT findings are helpful in making a diagnosis of subdural tension pneumocephalus following surgery for chronic subdural hematoma.

Aged↗
PubMed1998

Spontaneous otogenic pneumocephalus. Case report and review of the literature.

Pneumocephalus is commonly seen in clinical neurosurgical practice. Typical causes include trauma, tumor, and infection. Pneumocephalus may also occur iatrogenically at the time of intracranial surgery; it is not pathological and may be seen routinely on postoperative neuroimaging. Pneumocephalus is rarely encountered in the absence of the aforementioned entities. The authors report on an elderly woman in whom spontaneous intraventricular pneumocephalus occurred because of a congenital defect in the left tegmen tympani. Eustachian tube closure and middle ear exclusion were used to obliterate the fistulous connection. This case illustrates both an unusual cause and a unique treatment for spontaneous otogenic pneumocephalus.

Aged↗
PubMed2001

[Pneumocephalus as a complication to sinus surgery].

BACKGROUND: Pneumocephalus is a rare complication of sinus surgery. The complications of sinus surgery are often classified as minor or major. Minor complications are seen as adhesions, scarring, bleeding, development of subcutaneous emphysema, penetration of the orbit without herniation and eyelid ecchymosis. The incidence of major complications is 0 to 3% and include haemorrhage, retrobulbar haematoma, injury to the optic nerve, CSF leaks, meningitis, intracranial penetration with development of tension pneumocephalus, and death. MATERIAL AND METHODS: We present a case of pneumocephalus after endonasal ethmoidectomy. The literature is reviewed. RESULTS: The patient had clinical findings consistent with non-tension pneumocephalus. Development of tension pneumocephalus is a distinct possibility and it is necessary to monitor these patients closely. INTERPRETATION: In order to reduce the risk of injury to the anterior skull base it is important to eliminate certain normal anatomic variations and to assess the individual anatomy thoroughly. This can be done with preoperative nasal endoscopy and CT imaging. This applies even more to patients who have previously undergone sinus surgery.

Aged↗
PubMed1977

[The relation of intracranial air to C.S.F. rhinorrhoea in the traumatic pneumocephalus (intracerebral and ventricular) (author's transl)].

The relation of intracranial air to C.S.F. rhinorrhoea in our four cases, one intracerebral and the others intracerebral-ventricular pneumocephalus, were investigated on their clinical course, operative findings and RI-cisternographic findings. In the occurrence of the pneumocephalus, it seemed important for the damaged brain to herniate into the defect of the bone and dura matar. Clinically in the stage of an intracerebral pneumocephalus, the C.S.F. rhinorrhoea was not recognized as a rule. And next stage, the sudden effusions of C.S.F. appeared when the intracerebral pneumocephalus developed to the intracerebral-ventricular pneumocephalus.

Adolescent↗
PubMed1992

Delayed intraventricular tension pneumocephalus complicating posterior fossa surgery for cerebellar medulloblastoma.

A child is described in whom intraventricular tension pneumocephalus developed 10 days after removal of a cerebellar medulloblastoma and 1 day after suture removal. The tension pneumocephalus was associated with hydrocephalus and CSF leakage from the suture line. The symptoms of the pneumocephalus were rapidly progressing loss of consciousness and hemiplegia which were promptly reversed upon aspiration of the intracranial air. A large amount of intraventricular air present in the immediate postoperative period was, however, clinically silent. The characteristics of this unusual presentation, its relation to asymptomatic pneumocephalus, hydrocephalus and the preventive and therapeutic measures required to deal with such conditions are discussed.

Cerebellar Neoplasms↗
PubMed2000

Pneumocephalus associated with aqueductal stenosis: three-dimensional computed tomographic demonstration of skull-base defects.

Ventriculoperitoneal (VP) shunt placement in patients with aqueductal stenosis has recently been reported as a cause of pneumocephalus. We report on a patient with pneumocephalus associated with aqueductal stenosis treated by VP shunting. A 29-year-old woman who had undergone a shunt operation for aqueductal stenosis 7 years previously sustained a whiplash injury in a minor traffic accident. Computed tomography (CT) revealed massive subdural pneumocephalus, and three-dimensional reconstructions of CT images clearly demonstrated defects in the skull base overlying the ethmoid sinuses. Both endoscopic III ventriculostomy and placement of external ventricular drainage were came free of symptoms and rhinorrhea ceased. Three-dimensionally reconstructed CT images were useful in detecting the extent of the patient's skull base defect. III Ventriculostomy was not effective in this case. Direct closure of the skull base by craniotomy was not necessary, and a programmable valve system was effective in preventing recurrence of either pneumocephalus or rhinorrhea.

Adult↗