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Lim Y, Dahapute A, Clarke A, Hutton M, Selbi W. Delayed tension pneumocephalus and pneumorrhacis after routine cervical spine surgery treated successfully without burr holes. Ann R Coll Surg Engl 2024; 106:555-560. [PMID: 37381753 PMCID: PMC11214862 DOI: 10.1308/rcsann.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/30/2023] Open
Abstract
Tension pneumocephalus (TP) after spinal surgery is very rare with only a few cases reported in the English literature. Most cases of TP occur rapidly after spinal surgery. Traditionally, TP is managed using burr holes to relieve intracranial pressure. However, our case highlights a rare delayed presentation of TP and pneumorrhacis 1 month after routine cervical spine surgery. It is to our knowledge the first case of TP after spinal surgery to be treated using dural repair and supportive care. A 75-year-old woman presented with TP after having routine cervical decompression and stabilisation for cervical myelopathy. She re-presented 1 month after her initial operation with a leaking wound and altered mental status, which deteriorated rapidly shortly after admission. This, in combination with her radiographic features, influenced the decision to explore her surgical wound emergently. She made a full recovery and was discharged after 2 weeks in hospital. We hope to emphasise the need for a high index of suspicion for cerebrospinal fluid leaks and the low threshold to return to theatre to repair a potential dural defect, as well as illustrate that TP after spinal surgery can be treated successfully without burr holes.
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Affiliation(s)
- Y Lim
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - A Dahapute
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - A Clarke
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - M Hutton
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - W Selbi
- Royal Devon and Exeter NHS Foundation Trust, UK
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Pneumocephalus secondary to a spinal surgery: A literature review and a case report. Int J Surg Case Rep 2021; 86:106342. [PMID: 34479115 PMCID: PMC8414181 DOI: 10.1016/j.ijscr.2021.106342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/17/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction We report a case of pneumocephalus, which is identified as the presence of air in the cranial cavity and is a rare complication after spinal surgeries, in addition to a literature review of similarly reported cases. Case presentation The patient is a 63-year-old male who developed pneumocephalus after undergoing a minimally invasive left side decompression at L3-L4 with left L4 foraminotomy even though there were no signs of dural tears or Cerebrospinal Fluid (CSF) leaks. After the diagnosis of pneumocephalus using brain Magnetic Resonance Imaging (MRI), the patient was treated conservatively and was discharged after 3 weeks without developing further complications. Discussion Pneumocephalus is defined as an abnormal accumulation of air within the cranial cavity. It can occur due to a variety of causes but rarely due to gas forming bacteria. Many theories are suggested concerning the pathophysiology of pneumocephalus, the inverted bottle theory, the ball valve theory, the Nitrous Oxide (N2O) theory, and as we outweigh in our case, gas forming bacteria theory. Pneumocephalus can be treated surgically, nevertheless, conservative management methods of such cases are usually followed. Conclusion The aim of this study is to draw further attention to the management and diagnosis of such surgical complication. A more extended research is needed to provide a full comprehensive approach to deal with this problem if faced in the future. To the best of our knowledge, this study reports the first pneumocephalus case induced by a postoperative bacterial infection in the global English based medical literature. Pneumocephalus caused by gas forming infection in the spine is a rare complication after spinal surgery. Unexplained headache spinal surgeries should raise suspicion toward pneumocephalus. There are many theories regarding the development of pneumocephalus, each one need specific attention.
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Jain A, Dave B, Degulmadi D, Krishnan A, Bang P. Symptomatic pneumocephalus following spine surgery: An institutional experience and review of literature. INDIAN SPINE JOURNAL 2020. [DOI: 10.4103/isj.isj_4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gader G, Karmeni N, Ben Saïd I, Jemel H. Symptomatic pneumocephalus: A rare complication of discal herniation's surgery. J Spinal Cord Med 2019; 42:810-812. [PMID: 29791307 PMCID: PMC6830202 DOI: 10.1080/10790268.2018.1476000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Context: We report the case of a 40-year-old woman with no pathological history, operated from an L4-L5 disc herniation by a left unilateral approach. The dura mater enveloping the left L5 root was accidentally injured at its lateral face causing a breach with CSF leakage. This breach could not be sutured. A few hours after waking, the patient presented an agitation followed by three generalized tonico-clonic seizures. Cerebral imaging revealed pneumocephalus. The patient was hospitalized in an intensive care unit. The symptoms gradually faded and the patient was discharged 3 days after surgery.Findings: Pneumocephalus is defined by the presence of air inside the skull. The symptoms of pneumocephalus are generally non-specific and varied, and this complication should also be kept in mind to prevent potentially severe course. The prevention of postoperative pneumocephalus depends on a well-defined strategy in the case of iatrogenic dural tear.Conclusions: Symptomatic pneumocephalus is a very rare complication in the course of lumbar surgery. Conservative therapy may be appropriate even in severe symptomatic manifestations.
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Affiliation(s)
- Ghassen Gader
- Department of Neurosurgery, National Institute of Neurology, Tunis, Tunisia,Correspondence to: Ghassen Gader, PO Box 152, 8050 Hammamet, Tunisia.
| | - Nadhir Karmeni
- Department of Neurosurgery, National Institute of Neurology, Tunis, Tunisia
| | - Imed Ben Saïd
- Department of Neurosurgery, National Institute of Neurology, Tunis, Tunisia
| | - Hafedh Jemel
- Department of Neurosurgery, National Institute of Neurology, Tunis, Tunisia
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Nam KH, Song Y, Kim DH, Choi HJ, Lee IS, Lee JI, Choi BK, Han IH. Symptomatic Pneumocephalus After Spinal Intradural-Extramedullary Tumor Surgery. World Neurosurg 2019; 130:e344-e349. [PMID: 31229753 DOI: 10.1016/j.wneu.2019.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Durotomy is a necessary procedure for resection of spinal intradural-extramedullary (IDEM) tumor. The purpose of this study was to investigate the prevalence and clinical implications of pneumocephalus after spinal IDEM tumor surgery and also the association between pneumocephalus and postoperative headache. METHODS This prospective study was conducted in a cohort of 20 patients who were diagnosed with a spinal IDEM tumor and underwent surgical resection. The mean patient age was 53.6 years (range, 29-75 years). Histological findings revealed schwannoma in 16 cases (80.0%) and meningioma in 4 cases (20.0%). Brain computed tomography scan was performed immediately after surgery. The prevalence and severity were analyzed based on the classification into 4 groups according to the extension of pneumocephalus: absence, mild, moderate, and severe. A visual analog scale (VAS; range 0-10) for headache was reported daily for the first postoperative week. Headache-related pneumocephalus was defined as a VAS score of ≥5 points at least once in that 1-week period. RESULTS The prevalence of pneumocephalus was 90.0% (18 patients). Five patients (25.0%) had severe pneumocephalus extending to the extra-axial space. Seven of the 20 patients (38.9%) complained of significant headache. Five of these patients had severe pneumocephalus, 1 patient had moderate pneumocephalus, and 1 patient had moderate pneumocephalus. A statistically significant association was observed between the severity of pneumocephalus and headache (P = 0.001). CONCLUSIONS Pneumocephalus is a common complication after spinal IDEM tumor surgery. This report is the first study to investigate the prevalence of pneumocephalus and analyze its association with headache after spine surgery. The severity of pneumocephalus was significantly related to postoperative headache.
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Affiliation(s)
- Kyoung Hyup Nam
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Youseon Song
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dong Hwan Kim
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Sook Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
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Cunqueiro A, Scheinfeld MH. Causes of pneumocephalus and when to be concerned about it. Emerg Radiol 2018; 25:331-340. [DOI: 10.1007/s10140-018-1595-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/23/2018] [Indexed: 01/05/2023]
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Özdemir U. A Rare Complication of Lumbar Spinal Surgery: Pneumocephalus. Korean J Neurotrauma 2017; 13:176-179. [PMID: 29201857 PMCID: PMC5702758 DOI: 10.13004/kjnt.2017.13.2.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022] Open
Abstract
A 25-year-old male patient with severe thigh and right side pain was presented. In the lumbar magnetic resonance images, there was a contrasting spinal cord tumor image with 1 cm in diameter at the level of the L3 vertebra. The patient was operated and the tumor was totally removed. All the pain of the patient recovered. The patient's postoperative two days were very comfortable and the patient was early mobilized. On the third postoperative day, the patient complained of severe headache, nausea and vomiting. Immediate cranial computed tomography (CT) images was performed. Cerebral pneumocephalus was present in CT. The patient was treated with definite bed rest and plenty of fluid replacement. After three days, the patient's complaints were completely improved. This improvement was confirmed by performing a cerebral CT scan. In the formation of pneumocephalus, air is compressed into the intradural space during operation and this passes to the cerebral space. Definite bed rest, abundant fluid replacement and, in addition, highly inspired oxygen therapy are sufficient to correct the condition.
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Affiliation(s)
- Uğur Özdemir
- Department of Neurosurgery, Ministry of Health, Beykoz State Hospital, Istanbul, Turkey
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Kieser DC, Cawley DT, Tavolaro C, Cloche T, Roscop C, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Delayed post-operative tension pneumocephalus and pneumorrhachis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:231-235. [PMID: 28871507 DOI: 10.1007/s00586-017-5268-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/25/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The incidence of pneumocephalus and pneumorrhachis after spinal surgery is unknown, with a paucity of literature on this complication. MATERIALS AND METHODS We present the first published case of delayed onset tension pneumocephalus and pneumorrhachis associated with spinal surgery. RESULTS This complication occurred from a cerebro-spinal fluid (CSF) leak after posterior instrumentation removal and was successfully treated with emergent wound debridement and the formation of a CSF fistula. CONCLUSIONS This case illustrates that delayed post-operative tension pneumocephalus and pneumorrhachis can occur after spinal surgery in a patient with a CSF leak. It also illustrates that pneumocephalus and pneumorrhachis can be easily diagnosed with cross-sectional CT imaging. Furthermore, in a patient with rapid deterioration emergent surgical debridement may be necessary. Lastly, if the dural tear cannot be identified intra-operatively, the formalization of a CSF fistula should be considered.
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Affiliation(s)
- D C Kieser
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Tavolaro
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - T Cloche
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - Cecile Roscop
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - V Pointillart
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - J M Vital
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - O Gille
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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Kizilay Z, Yilmaz A, Ismailoglu O. The effect of the previous craniectomy on the formation of tension pneumocephalus after spinal dural injury: A case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2016.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gauthé R, Latrobe C, Damade C, Foulongne E, Roussignol X, Ould-Slimane M. Symptomatic compressive pneumocephalus following lumbar decompression surgery. Orthop Traumatol Surg Res 2016; 102:251-3. [PMID: 26796946 DOI: 10.1016/j.otsr.2015.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 02/02/2023]
Abstract
We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2-L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, computed tomography was performed to explore intense lumbar pain and revealed a voluminous pneumorachis. Then, the patient experienced a generalized tonic-clonic seizure. Imaging revealed a voluminous pneumocephalus responsible for a significant space-occupying effect on the frontal lobe. A conservative treatment was initiated, including bed rest, oxygen therapy, neurological monitoring and anti-epileptic therapy. Symptoms gradually improved and he was discharged without any deficit after 10 days. A total radiological regression was noted in 21 days. Prevention of postoperative pneumocephalus should include a systematic repair of iatrogenic dural tear. Even in presence of severe symptomatic manifestations, a conservative treatment is possible.
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Affiliation(s)
- R Gauthé
- Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
| | - C Latrobe
- Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Damade
- Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - E Foulongne
- Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - X Roussignol
- Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - M Ould-Slimane
- Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
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Kizilay Z, Yilmaz A, Ismailoglu O. Symptomatic Pneumocephalus after Lumbar Disc Surgery: a Case Report. Open Access Maced J Med Sci 2015; 3:143-5. [PMID: 27275212 PMCID: PMC4877774 DOI: 10.3889/oamjms.2015.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 11/05/2022] Open
Abstract
Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.
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Affiliation(s)
- Zahir Kizilay
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ali Yilmaz
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ozgur Ismailoglu
- Süleyman Demirel University, Neurosurgery, 32260 Isparta, Turkey
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Karavelioglu E, Eser O, Haktanir A. Pneumocephalus and pneumorrhachis after spinal surgery: case report and review of the literature. Neurol Med Chir (Tokyo) 2013; 54:405-7. [PMID: 24305016 PMCID: PMC4533435 DOI: 10.2176/nmc.cr2013-0118] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patient's complaints resolved within 10 days.
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Affiliation(s)
- Ergun Karavelioglu
- Department of Neurosurgery, Afyon Kocatepe University, School of Medicine
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