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Complications of CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
Approximately 75–80% of cases of pneumocephalus are caused by trauma.8,9 In 1884, Chiari was the first to describe this entity.10 A reduced intracranial pressure with a defect in the dura are required for its development. The mechanism for its formation is either by negative pressure created by the leaking CSF and subsequent air entry, or a ball valve mechanism allowing air entry in a unilateral direction.8
Positions in neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Zilvinas Zakarevicius, Mikhail Gelfenbeyn, Irene Rozet
Pneumocephalus is defined as the presence of air within any of the intracranial compartments. The mechanism of pneumocephalus is under pressure compared with the outside atmospheric pressure, when in most circumstances a valve mechanism allows air to enter the skull but prevents it from escaping, thus creating a pressure differential. While simple pneumocephalus occurs nearly in all patients after sitting neurosurgery and is typically asymptomatic and requires no treatment, tension pneumocephalus is rare (about 3%) (37). Clinical deterioration of the patient is usually abrupt due to increased ICP secondary to pneumocephalus, and requires immediate surgical decompression. Clinical signs of postoperative tension pneumocephalus include delayed awakening, new neurological deficit, headache, and signs of increased ICP. Consider immediate head computerized tomography (CT) for differential diagnosis. Twist drill hole and dural puncture for decompression may be considered for treatment if needed.
Depressed skull fracture pneumocephalus
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Conservative management. Pneumocephalus, or the presence of air in the intracranial cavity, is most frequently caused by trauma, but can also be caused by intracranial or spinal surgeries and infections. Symptoms can include nausea and vomiting, headaches, dizziness, and seizures. A tension pneumocephalus is created when the intracranial air causes increased intracranial pressure and neurological deterioration, which is fatal if untreated. Isolated pneumocephalus is usually conservatively treated and observed as the air will be absorbed without any complications. If there are concerns for increased intracranial pressure, then emergent surgical decompression may be required.
Failure of anterior skull base reconstruction for sinonasal carcinoma: consequence on the postoperative follow up. A multicentre evaluation of management
Published in Acta Oto-Laryngologica, 2021
Nicolas Saroul, Cécile Rumeau, Benjamin Verillaud, Vincent Patron, Christian Righini, Guillaume De Bonnecaze, Clémentine Daveau, Geoffrey Mortuaire, Thierry Mom, Laurent Gilain, Bruno Pereira, Laura Montrieul
Opinions differ on the need for postoperative imaging. Some authors recommend it to detect clinically silent pneumocephalus or hematomas [14] while others argue against it because they maintain that in absence of neurological symptoms clinical management will not change [13]. Pneumocephalus is common after opening the dura and is found in almost half of cases as, for example, in the study of Nadimi et al., in which 44% of patients were affected [13]. However, only growing and extensive pneumocephalus is a sign of reconstruction failure, as was the case for 2 patients in our series. Banu et al. defined ‘suspicious’ pneumocephalus as a pattern of air in the convexity, interhemispheric fissure, sellar, parasellar or perimesencephalic regions that could be associated with a CSF leak [15]. In our series, a CSF leak was associated with pneumocephalus in 2 patients (8%). We believe that in cancer surgery postoperative imaging is still necessary to look at complications and at the quality of the tumor resection.
An enemy hides in the ceiling; pediatric traumatic brain injury caused by metallic ceiling fan: Case series and literature review
Published in British Journal of Neurosurgery, 2019
Samer S. Hoz, Ali A. Dolachee, Husain A. Abdali, Hidetoshi Kasuya
The salient feature of the CT-scan finding after ceiling fan head injury is that there is no intracranial injury without a skull fracture. Additionally, this is supported by 100% of positive CT-scan finding that associated with skull fracture in our patients (Table 3) and by comparable series.3,5 Moreover, most of the skull fractures are compound depressed (Figures 2 and 3). In contrast, the study of Furyk et al.4 showed a less frequent fracture because they were focused more on superficial scalp injuries which forms the majority of their patients. Furthermore, contusions and pneumocephalus are common findings in this type of injury; 48.3% and 86.2% respectively, which may explain 20.7% occurrence of seizure in our patients at presentation (Table 3). Similarly, the study of Alias et al.3 reported three out of 14 patients with pneumocephalus in their cranial CT-scan.
A prospective randomized clinical trial to evaluate the impact of intraoperative ventilation with high oxygen content on the extent of postoperative pneumocephalus in patients undergoing craniotomies
Published in British Journal of Neurosurgery, 2019
G. Sandhu, A. Gonzalez-Zacarias, J. Fiorda-Diaz, S. Soghomonyan, M. Abdel-Rasoul, L. M. Prevedello, A. A. Uribe, N. Stoicea, D. Targonski, D. M. Prevedello, S. D. Bergese
Pneumocephalus has been defined as a collection of air in the cranial cavity most commonly found during the radiologic examination after craniotomies.1 Its onset may be spontaneous, associated with neurosurgery, craniofacial trauma, skull base tumors, and infections.1–3 Some of the perioperative factors contributing to the development of pneumocephalus are head positioning, intraoperative use of mannitol, nitrous oxide (N2O), hyperventilation, or continuous cerebrospinal fluid (CSF) drainage.2,4 Likewise, the size of the intracranial lesion, type of surgery, and surgical approach have been linked to the onset and extent of postoperative pneumocephalus. Moreover, its incidence has been reported as high as 100% after craniotomies, frontal area being the most commonly affected.2,4