A Rare Complication of Lumbar Spinal Surgery: Pneumocephalus

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.

Delayed pneumocephalus induced by repeated percutaneous aspiration after spinal surgery

“…Postoperative pneumocephalus is often caused by dural injury. [ 3 , 4 ] The presence of a dural injury was probably overlooked in our case.…”

“…Pneumocephalus of spinal origin may be associated with fractures caused by spinal trauma, [ 12 ] operative injury [ 3 , 4 , 7 , 8 , 10 ] Table 1 , tumors, application of H 2 O 2 , [ 1 , 2 ] increased intra-abdominal pressure, [ 6 ] or some diagnostic and therapeutic procedures, such as a lumbar puncture. Iatrogenic pneumocephalus [ 1 – 4 , 7 , 8 , 10 , 11 ] are not rare during spinal operation. Postoperative pneumocephalus is often caused by dural injury.…”

“…[ 6 ] Hyperbaric oxygen therapy (set at 2.5 atmospheres, 110 minutes) may be a better choice to facilitate reabsorption of pneumocephalus. [ 14 ] Pneumocephalus usually resolves after several days [ 3 , 4 ] to several weeks. [ 7 , 10 ] When clinical symptoms such as intracranial hypertension and unconsciousness indicate a threat to life, urgent decompression should be considered to relieve intracranial hypertension.…”

“…Generally, pneumocephalus of small volume or some tension pneumocephalus without severe symptoms can be treated conservatively, [4][5][6][7] Table 1. Conservative treatment include bed rest, avoiding the Valsalva maneuver (i.e., coughing and sneezing), abundant fluid replacement, and administering analgesics and osmotic diuretics such as mannitol.…”

“…Consequently, surgeons face increasing numbers of dural tears and cerebrospinal fluid (CSF) leaks; CSF leakage secondary to a dural injury can cause pneumocephalus. [3,4] Most pneumocephalus occur within 1 to 3 days [4][5][6][7] after spinal surgery, and cases complicated by delayed pneumocephalus are rarely reported. However, there is a paucity of data on how to avoid the pneumocranium after spinal surgery.…”