Anesthetic technique and development of pneumocephalus after posterior fossa surgery in the sitting position

Hérnández-Palazón, J; Rosa-Carrillo, V Nuño de la; Tortosa, J. A.

doi:10.1016/s1130-1473(03)70540-5

Cited by 27 publications

(14 citation statements)

References 19 publications

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“…6 Pneumocephalus is a well-known complication of spinal and epidural anaesthesia, but is extremely rare after diagnostic or therapeutic lumbar puncture. 7 Possible complications that can occur as a result of lumbar decompression include dural tear with associated CSF leak, retroperitoneal and nerve root injury, pseudoarthrosis, infection, instability and nerve root damage.…”

Section: Discussionmentioning

confidence: 99%

Pneumocephalus – a possible cause of post-spinal surgery confusion

Dhamija

Saxena

2011

J R Soc Med

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This case illustrates the need to consider pneumocephalus (intracranial air) in the differential when cognitive changes develop following spinal surgery. IntroductionLumbar decompression for acute and chronic degenerative spinal pathology is one of the most common procedures performed by spinal surgeons, neurosurgeons and some orthopaedic surgeons. It is associated with several recognized complications, however, the presence of intracranial air (pneumocephalus) postoperatively is generally not a recognized feature.To the authors' knowledge there have been no previous reports of pneumocephalus arising secondary to lumbar decompression. Case reportA 63-year-old woman with a background of chronic degenerative lumbar spinal stenosis presented as an elective for re-do L3, L4 and L5 decompression. The MRI scan of her lumbo-sacral spine revealed posterior disc protrusions at L3/4 and L4/5 levels.She underwent revision laminectomy, performed at L3/4 and L4/5 to decompress the lateral recesses at these levels. Adequate decompression was performed; however, it was noted that dural leak had occurred, this was sealed with a 3.0 prolene stitch, duragen and tisseal application. The tissues closed in layers and staples applied to the skin.For cerebrospinal fluid (CSF) leak the patient was managed with strict, flat bed rest for 48 hours postoperatively.Less than 24 hours postoperatively, it was noticed that she had become confused, restless, disoriented and complaining of headache. She was mildly febrile, with a temperature of 37.9°C. Her physical examination was unremarkable.A CT head scan performed the same day ( Figure 1) showed pneumocephalus, the presence of air within the cisterns and the ventricular system.To hasten recovery, she was administered with high flow oxygen at a rate of 10 L per minute, and by 5 days the confusion had settled, with complete resolution of the intracranial air on repeat CT imaging.

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Section: Discussionmentioning

confidence: 99%

Pneumocephalus – a possible cause of post-spinal surgery confusion

Dhamija

Saxena

2011

J R Soc Med

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“…Therefore, the possibility of pulmonary air embolisms occurring is relatively high, and such embolisms are mentioned increasingly in clinical reports [10][11][12]. Domaingue [10] investigated the incidence of venous air embolisms in 58 patients undergoing sitting-position surgeries and showed that the incidence was as high as 43%, but most of the air embolisms were small to medium in size.…”

Section: Discussionmentioning

confidence: 99%

TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery

Wang

et al. 2010

Sci. China Life Sci.

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“…Some degree of postsurgical pneumocephalus occurs in all patients [31]. The decisive factor for the evolution of pneumocephalus is the position of the head during surgery and during closure [8,[31][32][33][34].…”

Section: Prevention and Avoidance Of Contributing Factorsmentioning

confidence: 99%

“…The decisive factor for the evolution of pneumocephalus is the position of the head during surgery and during closure [8,[31][32][33][34]. Other factors are the use of standard techniques during surgery that allow for easier and safer brain manipulation including drainage of CSF, dehydration with the use of diuretics or mannitol, hyperventilation and decompression, or resection of spaceoccupying lesions.…”

Section: Prevention and Avoidance Of Contributing Factorsmentioning

confidence: 99%

“…Some authors have implied N 2 O in the pathogenesis of postsurgical pneumocephalus [30,35,36], whereas others have questioned its role [28,[37][38][39][40]. Presently, there is no evidence, including data from randomized clinical trials, to show that any particular anesthetic technique can either increase or decrease the amount of pneumocephalus after neurosurgical procedures [28,31,40].…”

Section: Prevention and Avoidance Of Contributing Factorsmentioning

confidence: 99%

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Pneumocephalus: Case Illustrations and Review

2010

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Pneumocephalus is commonly encountered after neurosurgical procedures but can also be caused by craniofacial trauma and tumors of the skull base and rarely, can occur spontaneously. Contributing factors for the development of pneumocephalus include head position, duration of surgery, nitrous oxide (N(2)O) anesthesia, hydrocephalus, intraoperative osmotherapy, hyperventilation, spinal anesthesia, barotauma, continuous CSF drainage via lumbar drain, epidural anesthesia, infections, and neoplasms. Clinical presentation includes headaches, nausea and vomiting, seizures, dizziness, and depressed neurological status. In this article, we review the incidence, mechanisms, precipitating factors, diagnosis, and management of pneumocephalus. Search of Medline, databases, and manual review of article bibliographies. Considering four case illustrations that typify pneumocephalus in clinical practice, we discuss the common etiologies, and confirm the diagnosis with neuroimaging and management strategies. Avoidance of contributing factors, high index of suspicion, and confirmation with neuroimaging are important in attenuating mortality and morbidity. A significant amount of pneumocephalus can simulate a space-occupying lesion. Supplemental oxygen increases the rate of absorption of pneumocephalus.

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Anesthetic technique and development of pneumocephalus after posterior fossa surgery in the sitting position

Cited by 27 publications

References 19 publications

Pneumocephalus – a possible cause of post-spinal surgery confusion

Pneumocephalus – a possible cause of post-spinal surgery confusion

TEE monitoring for RA-horizontal paradoxical arterial air embolism during sitting-position surgery

Pneumocephalus: Case Illustrations and Review

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