Intraoperative Subdural Tension Pneumocephalus Arising after Opening of the Dura

Goodie, David B.; Traill, Roger

doi:10.1097/00000542-199101000-00032

Cited by 11 publications

(6 citation statements)

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“…Pneumocephalus is said to be more common following sitting position craniotomy than after similar surgery in other positions 37,38 . It has also been claimed that the risk of pneumocephalus dictates that nitrous oxide should not be used 39 . In fact, the use of nitrous oxide up to the point of dural closure may be advantageous, as the gas pocket may shrink more quickly in the presence of nitrous oxide.…”

Section: (4) Pneumocephalusmentioning

confidence: 99%

Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach

2005

Anaesth Intensive Care

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Neurosurgery in the sitting position offers advantages for certain operations. However, the approach is associated with potential complications, in particular venous air embolism. As the venous pressure at wound level is usually negative, air can be entrained. This air may follow any of four pathways. Most commonly it passes through the right heart into the pulmonary circulation, diffuses through the alveolar-capillary membrane and appears in expelled gas. It may pass through a pulmonary-systemic shunt such as a probe patent foramen ovale (paradoxical air embolism); it may collect at the superior vena cava-right atrial junction. Rarely it may traverse through lung capillaries into the systemic circulation. Many monitors, such as the precordial Doppler, capnography, pulmonary artery catheter, transoesophageal echocardiography are useful for venous air embolism detection, with transoesophageal echocardiography being today's gold standard. Various manoeuvres, including neck compression and volume loading, are also useful in reducing the incidence of venous air embolism. Volume loading, in particular, is very helpful as it reduces the risk of hypotension. Other particular concerns to the anaesthetist are airway management, avoidance of pressure injuries, and the risk of pneumocephalus, oral trauma, and quadriplegia. Newer anaesthetic agents have made the choice of anaesthetic technique easier. An appreciation of the implications of neurosurgery in the sitting position can make the procedure safer.

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Section: (4) Pneumocephalusmentioning

confidence: 99%

Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach

2005

Anaesth Intensive Care

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“…[ 8 ] Some authors reported that small craniotomy with irrigation and closed system drainage can be considered as one of the treatment options in patients with CSDH. [ 17 18 19 ] Conversely, craniotomy is generally accepted as the optimal approach for OCSH, reaccumulation of a CSH, existence of a solid hematoma, failure of brain reexpansion, or marked swelling subjacent to the hematoma. [ 5 6 20 21 ] In OCSH cases, a two burr hole craniostomy cannot be considered as the solution of initial choice.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 6 20 21 ] In OCSH cases, a two burr hole craniostomy cannot be considered as the solution of initial choice. [ 6 7 18 ] We have treated, these cases, by craniotomy in the conviction of the need to achieve the widest possible membranectomy. Many authors reported that OSDH required a large craniotomy for the initial treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7]22] Large craniotomies for OSDH provided a superior and safer opportunity to adequately deal with the hematoma, its membranes, and occasional troublesome bleeding. [5,6,18,22] Extended outer and inner membranectomy is very important for brain expansion for subdural space. [5,21,22] The outer membrane is related to hematoma enlargement because of the repetitive hemorrhages, [2,23] whereas the inner membrane is related to liquefaction of the subdural hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…[5,7,12,22,[28][29][30] Among the most frequently confirmed causes of recurrence is the presence of thick membranes in the hematoma, which lead to a higher recurrence rate. [5,7] Occasionally, advanced age has been considered to be a risk factor for recurrence after CSDH operations, [16,18] but most studies have demonstrated no relationship between recurrence rate and age. [12,[31][32][33] Pneumocephalus is the presence of air in the cranial cavity.…”

Section: Discussionmentioning

confidence: 99%

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Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment

Balevi

2017

Asian J Neurosurg

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Objective:The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH).Materials and Methods:We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH).Results:Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%.Conclusion:Large craniotomy and extended membrane excision for OSDH still carry a high rate of mortality and morbidity in elderly patients. TP, RSH, and postoperative seizures are frequently seen complications in elderly patients.

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Nitrous oxide

2006

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions

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Intraoperative Subdural Tension Pneumocephalus Arising after Opening of the Dura

Cited by 11 publications

References 0 publications

Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach

Anaesthesia for Neurosurgery in the Sitting Position: A Practical Approach

Organized chronic subdural hematomas treated by large craniotomy with extended membranectomy as the initial treatment

Nitrous oxide

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