Spontaneous Epidural Pneumocephalus  -Case Report-

Tucker, Adam; Miyake, Hiroji; Tsuji, Masao; Ukita, Tohru; Nishihara, Kentaro; Ito, Sachio; Ohmura, Takehisa

doi:10.2176/nmc.48.474

Cited by 20 publications

(27 citation statements)

References 21 publications

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“…The first case report of pneumocephalus was in 1741 by Lecat. (1,26) Its association with craniofacial trauma, neurosurgical or ontological procedures, (9,14,23,24) otomastoiditis,(5) or skull base tumours (21,27) is well known. Spontaneous pneumocephalus caused by a primary defect at the temporal bone level without association with pathological conditions or surgery is very rare.…”

Section: Discussionmentioning

confidence: 99%

A spontaneous Pneumocephalus and Hyperpneumatisation of occipital bone and atlas vertebra: a case report.

Sawant¹

2016

IOSR

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Section: Discussionmentioning

confidence: 99%

A spontaneous Pneumocephalus and Hyperpneumatisation of occipital bone and atlas vertebra: a case report.

Sawant¹

2016

IOSR

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“…The absence of a history of infection favors the congenital theory of a hyperpneumatized mastoid, with either an excessive bone resorption during pneumatization or faulty embryogenesis. An additional role of the eustachian tube functioning as a oneway valve may help to increase the air pressure [13][14][15]. (3) Spontaneous pneumocephalus can be caused by barotraumas, but this is extremely rare [14].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous otogenic pneumocephalus

Mohammed

Profant

2011

Acta Oto-Laryngologica

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The diagnosis and management of spontaneous otogenic pneumocephalus with literature review is described. A young sportsman experienced headache and fluctuating mass in his occiput during increased physical activity. A large extradural intracranial pneumocephalus with corresponding emphysema was imaged on a CT scan. Transmastoid identification and plugging of temporal bone defect solved the problem with complete pneumocephalus and emphysema resorption.

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“…Spontaneous pneumocephalus has also been described. 15,17,32,46,50,52 Initially reported on by Lecat in 1741, 16,49 the mechanism of pneumocephalus was further examined in 1884 by Chiari, who advanced the hypothesis of a fistular tract between paranasal sinuses and the cranial cavity. 34 In 1913, Luckett used plain skull radiographs to detect a traumatic pneumocephalus.…”

Section: Postoperative Pneumocephalusmentioning

confidence: 99%

“…24,27,40,41 Some authors have reported a 100% incidence of pneumocephalus if imaging is done within the first 2 days of supratentorial craniotomy. 50 Clearly, the timing and resolution of the imaging technique will alter pneumocephalus rates as air is progressively absorbed after surgery. There is little information on rates of pneumocephalus following ESBS.…”

Section: Postoperative Pneumocephalusmentioning

confidence: 99%

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Banu

Szentirmai

Mascarenhas

et al. 2014

JNS

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Object Postoperative pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS. Methods The authors queried a prospectively acquired database of 526 consecutive ESBS cases at a single center between December 1, 2003, and May 31, 2012, and identified 258 patients with an intraoperative CSF leak documented using intrathecal fluorescein. Postoperative CT and MRI scans obtained within 1–10 days were examined and pneumocephalus was graded based on location and amount. A discrete 0–4 scale was used to classify pneumocephalus patterns based on size and morphology. Pneumocephalus was correlated with the surgical approach, histopathological diagnosis, and presence of a postoperative CSF leak. Results The mean follow-up duration was 56.7 months. Of the 258 patients, 102 (39.5%) demonstrated pneumocephalus on postoperative imaging. The most frequent location of pneumocephalus was frontal (73 [71.5%] of 102), intraventricular (34 [33.3%]), and convexity (22 [21.6%]). Patients with craniopharyngioma (27 [87%] of 31) and meningioma (23 [68%] of 34) had the highest incidence of postoperative pneumocephalus compared with patients with pituitary adenomas (29 [20.6%] of 141) (p < 0.0001). The incidence of pneumocephalus was higher with transcribriform and transethmoidal approaches (8 of [73%] 11) than with a transsellar approach (9 of [7%] 131). There were 15 (5.8%) of 258 cases of postoperative CSF leak, of which 10 (66.7%) had pneumocephalus, compared with 92 (38%) of 243 patients without a postoperative CSF leak (OR 3.3, p = 0.027). Pneumocephalus located in the convexity, interhemispheric fissure, sellar region, parasellar region, and perimesencephalic region was significantly correlated with a postoperative CSF leak (OR 4.9, p = 0.006) and was therefore termed “suspicious” pneumocephalus. In contrast, frontal or intraventricular pneumocephalus was not correlated with postoperative CSF leak (not significant) and was defined as “benign” pneumocephalus. The amount of convexity pneumocephalus (p = 0.002), interhemispheric pneumocephalus (p = 0.005), and parasellar pneumocephalus (p = 0.007) (determined using a scale score of 0–4) was also significantly related to postoperative CSF leaks. Using a series of permutation-based multivariate analyses, the authors established that a model containing the learning curve, the transclival/transcavernous approach, and the presence of “suspicious” pneumocephalus provides the best overall prediction for postoperative CSF leaks. Conclusions Postoperative pneumocephalus is much more common following extended approaches than following transsellar surgery. Merely the presence of pneumocephalus, particularly in the frontal or intraventricular locations, is not necessarily associated with a postoperative CSF leak. A “suspicious” pattern of air, namely pneumocephalus in the convexity, interhemispheric fissure, sella, parasellar, or perimesencephalic locations, is significantly associated with a postoperative CSF leak. The presence and the score of “suspicious” pneumocephalus on postoperative imaging, in conjunction with the learning curve and the type of endoscopic approach, provide the best predictive model for postoperative CSF leaks.

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Spontaneous Epidural Pneumocephalus -Case Report-

Cited by 20 publications

References 21 publications

A spontaneous Pneumocephalus and Hyperpneumatisation of occipital bone and atlas vertebra: a case report.

A spontaneous Pneumocephalus and Hyperpneumatisation of occipital bone and atlas vertebra: a case report.

Spontaneous otogenic pneumocephalus

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

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