Endoscopic Repair of Tension Pneumocephalus

Aferzon, Mark; Aferzon, Joseph; Spektor, Zorik

doi:10.1177/019459980112400618

Cited by 10 publications

(18 citation statements)

References 3 publications

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“…13 However, many studies have reported that, regardless of the size of the skull base defect in TP, conservative treatment is ineffective because air will continue to enter the intracranial cavity through the existing skull base defect. 3,4,25 In addition, Aksoy et al described a case of TP with minimal skull base defect (only 1 mm), but the patient experienced a herniation table and serious neurological problems. 3 Thus, urgent surgical repair of skull base defects and/or release of intracranial pressure are key to treating patients with TP.…”

Section: Discussionmentioning

confidence: 99%

<p>Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review</p>

Liu

et al. 2020

TCRM

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Tension pneumocephalus (TP) caused by endoscopic endonasal surgery is a serious complication. We report four cases of TP caused by endoscopic surgery and review other cases in the literature, with special attention devoted to symptoms, imaging features, and therapeutic approaches. Methods: A retrospective chart review of patients who experienced TP caused by endoscopic surgery in our institution between 2015 and 2018 was performed. Additionally, the MEDLINE database was searched for all case series or reports of TP caused by endoscopic surgery. Results: Eighteen articles were identified for review, including four cases from the authors' institution; ultimately, 26 cases were included in the present study. The main symptoms of TP were headache and a change in mental status. Cerebrospinal fluid (CSF) leakage was reported in 21 of the 26 patients (80.8%). Eight of the 26 patients (30.8%) presented with the "Mount Fuji sign" imaging feature. Twenty-four patients were treated with surgical intervention for TP (endoscopic multilayer closure of skull base defect, cranial burr hole, or bifrontal craniotomy). In addition, the present study is the first to report two patients with TP who were successfully treated conservatively. Conclusion: The therapeutic method for treating TP should depend on the degree of the mass effect and clinical symptoms. When patients with TP present with obvious symptoms of CSF leakage and intracranial hypertension, urgent surgical multilayer repair of the skull base defects and/or release of the intracranial pressure are keys to treating these patients. However, conservative treatment under close observation is also feasible when the related symptoms are not overtly obvious.

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Section: Discussionmentioning

confidence: 99%

<p>Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review</p>

Liu

et al. 2020

TCRM

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“…The skull base is covered by a pericranial fl ap. With the introduction of minimally invasive approaches and better endoscopic techniques, the transnasal route gained more interest [2,4,15,16] . As in every technique it is important to precisely localise the leak before or during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…El-Banhaway et al [18] even described a combined overlay and underlay graft technique. Several studies report success rates of 90 -100 % [4,17] for closure after endonasal endoscopic approaches. Disadvantages of the intracranial approach are the risk of permanent anosmia and brain oedema.…”

Section: Discussionmentioning

confidence: 99%

“…Trauma is the most frequent cause of pneumocephalus and the cribriform plate is mostly involved [2,3] . Tension pneumocephalus is associated with increased intracranial pressure and can cause serious neurological deterioration requiring urgent intervention [4] . A computed tomographic (CT) scan of the brain demonstrates a massive accumulation of air compressing the frontal lobes in a pattern known as the " Mount Fuji " sign [5 -7] .…”

Section: Introductionmentioning

confidence: 99%

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Intradural Endoscopic Closure of Dural Breaches in a Case of Post-Traumatic Tension Pneumocephalus

Dewaele¹,

Caemaert²,

Baert³

et al. 2007

Minim Invasive Neurosurg

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After surgery, a gradual decrease of the amount of intracranial air was documented. The patient regained consciousness and was extubated. In spite of this favourable course, he suddenly died two weeks after surgery from combined pulmonary and renal dysfunction. Autopsy documented the efficacious endoscopic sealing of the skull base, which was the least invasive procedure in the given circumstances.

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“…Definitive repair has traditionally been via neurosurgical craniotomy approach. Over the past decade, however, endoscopic endonasal approaches have increasingly been employed (41) .…”

Section: Introductionmentioning

confidence: 99%

Intracranial abscess after anterior skull base defect: does pneumocephalus play a role?

Becker

Russel

2009

Rhin

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Background: Intracranial complications of skull base defects are uncommon; however, they can be devastating when they do occur. Often these complications arise suddenly and without warning. Identifying patients at risk for intracranial abscesses may help with early diagnosis and allow for early interventions. Objective: We report on 2 patients with traumatic pneumocephalus who developed intracranial abscesses. Our objective was to evaluate these cases and investigate the relationship between the presence of pneumocephalus and the formation of intracranial infection. Methods: Data was reviewed on the cases of 2 patients who developed intracranial abscesses after pneumocephalus in the context of skull base defects. Results: Two patients presented to our institution separately with the presence of intracranial abscesses. Both patients had violation of their anterior skull base-one from endoscopic sinus surgery, one from blunt trauma. Both patients had massive pneumocephalus prior to their abscess formation. Conclusions: Intracranial abscess formation, traumatic skull base defects, and massive pneumocephalus are uncommon entities, which may be associated. It may be prudent to have heightened suspicion for the presence of intracranial abscess formation in patients with massive pneumocephalus secondary to anterior skull base trauma.

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Endoscopic Repair of Tension Pneumocephalus

Cited by 10 publications

References 3 publications

<p>Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review</p>

<p>Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review</p>

Intradural Endoscopic Closure of Dural Breaches in a Case of Post-Traumatic Tension Pneumocephalus

Intracranial abscess after anterior skull base defect: does pneumocephalus play a role?

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