Clinical significance of acute traumatic intracranial pneumocephalus

Keskil, Semih; Baykaner, Kemali; Çeviker, Necdet; Işık, Sedat; Çengel, Mustafa; Orbay, Toygun

doi:10.1007/bf01111479

Cited by 26 publications

(32 citation statements)

References 17 publications

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“…CT also plays an important role in the diagnosis in head trauma including acute hemorrhage and cranial fractures. 11 Pneumocephalus is also evident on plain skull x-rays and fluoroscopy. 3 We used fluoroscopy to determine the location of pneumocephalus and while we were aspirating the gas, it showed real time image.…”

Section: Discussionmentioning

confidence: 98%

Is Fluoroscopy-Guided Drainage of Tension Pneumocephalus an Appropriate Intervention?: Surgical Technique

Demir¹,

Deniz²,

Öksüz³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T Tension pneumocephalus is not a common entity after head trauma. It requires urgent intervention when associated with raised intracranial pressure. A 22 year-old man was admitted in our emergency unit after being involved in a traffic accident. Initial assessment of the patient revealed a Gloskow Coma Score (GCS) of 8. Radiological exams showed left fronto-orbital depression fracture, left fronto-basal fracture and left frontal cerebral contusion. The patient was operated urgently. Depressed bones were elevated and cranial reconstruction was done. After the initial operation, his neurological level elevated day by day. Thirty days after the operation computed tomography (CT) scan showed left frontal pneumocephalus. Conservative treatment was initiated. First, the volume of air in the field decreased spontaneously but after strong coughing, the amount of air increased and showed resistance to absorption. The patient was reoperated. Left frontal pneumatic space was irrigated with physiologic saline until all air was evacuated. Fluoroscopy showed the location of the intracranial air and no air was left after evacuation. The patient recovered well. No intracranial air was detected in his follow-up. There is no standard surgical intervention for tension pneumocephalus. Fluoroscopy-guided drainage with punctuation needle for tension pneumocephalus is a minimally invasive and effective procedure.K Ke ey y W Wo or rd ds s: : Tension pneumocephalus; head trauma; surgical treatment Ö ÖZ ZE ET T Tansiyon pnömosefali, kafa travmalarından sonra sık görülen bir durum değildir. İntrakra-niyal basınçta artışa neden olduğunda acil müdahale gerektirir. Yirmi iki yaşında bir erkek hasta, trafik kazası geçirdikten sonrası acil servisimize başvurdu. Hastanın ilk nörolojik muayenesinde Glasgow Koma Skoru (GKS) 8 bulundu. Radyolojik çalışmalar, sol fronto-orbital çökme kırığı, sol frontobazal kırık ve sol frontal serebral kontüzyon olduğunu gösterdi. Hasta acilen ameliyat edildi. Operasyonda çökmüş kemikler kaldırıldı ve kraniyal rekonstrüksiyon yapıldı. İlk operasyondan sonra hastanın kliniği günden güne düzeldi. Otuz gün sonra hastaya çekilen bilgisayarlı tomografi (BT) incelemesinde sol frontal pnömosefali tespit edildi. Öncelikle hastaya konservatif tedavi başlandı. Önce alandaki hava miktarı spontan olarak azaldı. Fakat hastanın güçlü öksürmesinin ardın-dan, alandaki hava miktarı arttı ve absorbe olmadı. Hasta bunun üzerine tekrar operasyona alındı. Operasyonda sol frontal bölgedeki hava serum fizyolojik ile irrigasyonla boşaltıldı. Floroskopi intrakraniyal havanın lokalizasyonunu ve drenaj işlemi sonrasında da bölgede havanın kalmadığını gösterdi. Hasta iyileşti. Hastanın takiplerinde de intrakraniyal hava tespit edilmedi. Tansiyon pnö-mosefali için standart bir tedavi yöntemi yoktur. Tansiyon pnömosefalide floroskopi yardımlı ponksiyon iğnesiyle havanın drenajı, invaziv olmayan etkili bir yöntemdir.A An na ah ht ta ar r K Ke el li im me el le er r: : Tansiyon pnömosefali; kafa travması; cerrahi tedavi T...

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Section: Discussionmentioning

confidence: 98%

Is Fluoroscopy-Guided Drainage of Tension Pneumocephalus an Appropriate Intervention?: Surgical Technique

Demir¹,

Deniz²,

Öksüz³

et al. 2012

Turkiye Klinikleri J Med Sci

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“…[16,17] Dural tear and entrapped air could be sequelae of fractures involving anterior cranial fossa via siphon effect or a Valsalva maneuver. Entrapped air is usually seen as intracerebral, subdural and intraventricular in decreasing order of frequency and could be associated with rhinorrhea or sometimes oculorrhea.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Traumatic Cerebrospinal Fluid Fistulas with Associated Lesions

Alagöz

Dağlıoğlu

Korkmaz

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…Air may be detected rarely in more than 1 compartment. 10,11 We tested the hypothesis that 5 cm H 2 O of PEEP reduces the incidence of pneumocephalus in patients who undergo intradural tumor surgery because it increases the CSF pressure by way of increasing the intrathoracic pressure and minimizing the negative pressure effect caused by CSF leakage from the dural defect. In our study, widespread pneumoencephalus, particularly in prepontine area, was seen in patients who did not receive PEEP; however, there was only 1 case of pneumocephalus among patients who received 5 cm H 2 O of PEEP.…”

Section: Discussionmentioning

confidence: 99%

Positive End-expiratory Pressure Reduces Pneumocephalus in Spinal Intradural Tumor Surgery

Turgut¹,

Türkmen²,

Gokkaya³

et al. 2007

Journal of Neurosurgical Anesthesiology

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We tested the hypothesis that 5 cm H2O of positive end-expiratory pressure (PEEP) reduces the incidence of pneumocephalus in patients who undergo spinal intradural tumor surgery. Fifty-three ASA I to III patients who underwent thoracolumbar intradural tumor surgery between the years 2003 and 2006 were included in this study. All patients received propofol, fentanyl, and cisatracurium for induction of the anesthesia. Maintenance was provided by propofol infusion and, oxygen (50%) and air (50%). Group I (n=28) did not receive PEEP whereas group II (n=25) received PEEP as 5 cm H2O. Cranial computerized tomography was taken at 8 hours after the surgery and cases were evaluated for pneumocephalus using BAB Bs200ProP Image System software. Pneumocephalus areas between 0.03 and 4.24 cm2 were observed in 9 patients, 8 in group I and 1 patient in group II at the 8th postoperative hour, at various localizations. There were no neurologic findings in other patients except for 2 patients in group I who presented with headache and mental status change. Although the cerebrospinal fluid leakage is minimal, N2O is not used and the patients are well hydrated, pneumocephalus with neurologic deficits may occur in patients undergoing microsurgical spinal intradural tumor surgery in prone position. In our study, we showed that using 5 cm H2O PEEP perioperatively reduced the risk of pneumocephalus. However, more cases must be studied to support this hypothesis.

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Clinical significance of acute traumatic intracranial pneumocephalus

Cited by 26 publications

References 17 publications

Is Fluoroscopy-Guided Drainage of Tension Pneumocephalus an Appropriate Intervention?: Surgical Technique

Is Fluoroscopy-Guided Drainage of Tension Pneumocephalus an Appropriate Intervention?: Surgical Technique

Surgical Management of Traumatic Cerebrospinal Fluid Fistulas with Associated Lesions

Positive End-expiratory Pressure Reduces Pneumocephalus in Spinal Intradural Tumor Surgery

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