High-Flow Nasal Oxygen Therapy for Management of Postoperative Pneumocephalus

Abstract

Postoperative pneumocephalus (PNC) is very common in craniotomy surgeries. It can be asymptomatic or if present in more volumes can cause symptoms such as lethargy, headache, confusion, or even severe neurological deficit. Treatment of pneumocephalus with supplemental oxygen via facemask is a common neurosurgical practice. There is not much evidence of use of high-flow nasal oxygen therapy (HFNOT) for the management of PNC. Here we report a case of an 8-year-old boy with postoperative symptomatic pneumocephalus, which resolved with the application of supplemental oxygen via a high-flow nasal cannula with 30 L/min flow and FiO2 of 0.7 over 72 hours. High-flow nasal oxygen therapy can be an effective modality of treatment for postoperative PNC with added advantages of patient comfort and maintenance of warmth and moisture of the respiratory tract.

A Case Report on Pneumocephalus That Occurred Following an Epidural Ozone Injection During Percutaneous Lumbar Disc Decompression Surgery

“…In several case reports, supplemental oxygen has been shown to decrease intracranial air collection in patients with pneumocephalus (21). In a study involving 13 patients with postoperative pneumocephalus, those who breathed 100% oxygen using a nonrebreather mask for 24 hours showed a 65% reduction in pneumocephalus volume, compared to 31% for the control group (22).…”