Pneumocephalus: Case Illustrations and Review

Abstract

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.

Pneumocephalus: An unusual complication of lumbar arthrodesis. A clinical case and literature review

“…1,3 Different diagnostic procedures, mostly harmless, such as lumbar puncture, ventriculostomy and spinal anesthesia can cause the passage of air by an intrathecal route and lead to a significant pneumocephalus. 7 Barotrauma secondary to rapid changes in air pressure can turn benign, subclinical cases of pneumocephalus into symptomatic of tension pneumocephalus which require urgent treatment and evacuation.…”

“…1 The first case of pneumocephalus was described by Lecat in 1866, but the term pneumocephalus was first used by Wolff in 1914, to describe this infrequent condition. 2,3 Pneumocephalus is generally associated to lesions of the cranial vault following trauma, facial trauma and as a consequence of neurosurgery or otolaryngology procedures for the treatment of skull base tumors.…”

“…The latter refers to a collection of air at a lower pressure than the outer atmospheric pressure, thus creating a valve mechanism that causes the entry of air and prevents it from escaping, establishing a pressure differential and a cascade of adverse effects for the patient. 1 The incidence of pneumocephalus secondary to posterior vertebral arthrodesis is unknown. There are few reports published of tension pneumocephalus following vertebral spinal surgery.…”

A Patient with Massive Pneumocephalus without Sign of Tension Pneumocephalus

“…It is usually secondary to trauma, infection and tumor or it may be iatrogenic [1]. In general, this is due to a bone defect allowing communication between the intracranial compartment and one of the cranial sinuses.…”

A rare cause of reversible ophthalmoplegia: tension pneumocephalus with brainstem compression

“…Tension pneumocephalus (TP) is a rare condition that occurs after neurosurgical procedures, trauma, or infection by a gas-forming organism [2]. Symptoms depend on the structures involved and may include oculomotor and abducens nerve palsy [3].…”