Subdural Tension Pneumocephalus Following Surgery

Monajati, Ahmad; Cotanch, William W.

doi:10.1097/00004728-198210000-00006

Cited by 34 publications

(13 citation statements)

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“…It has been proposed that the volume of air as little 65 mL is sufficient enough to produce TP. [30] Subsequent to this finding, however, other authors demonstrated no substantial difference between the volume of air and the occurrence of TP. [29] After both clinical and imaging findings are appropriately recognized and correlated, definitive treatment is initiated.…”

Section: Discussionmentioning

confidence: 85%

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Pillai

Sharma

MacKenzie

et al. 2017

Int J Crit Illn Inj Sci

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Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion. Literature cases were combined with the 2 reported cases and analyzed for demographics, mechanism of injury, symptoms, time to presentation (acute <72 h; delayed >72 h), diagnostic/treatment modalities, and outcomes. Twenty cases were analyzed (17 males, 3 females, median age 26, range 8–92 years). Presentation was acute in 13/20 and delayed in 7/20 patients. Injury mechanisms included motor vehicle collisions (6/20), assault/blunt trauma to the craniofacial area (5), falls (4), and motorcycle/ bicycle crashes (3). Common presentations included depressed mental status (10/20), cerebrospinal fluid rhinorrhea (9), headache (8), and loss of consciousness (6). Computed tomography (CT) was utilized in 19/20 patients. Common underlying injuries were frontal bone/sinus fracture (9/20) and ethmoid fracture (5). Intracranial hemorrhage was seen in 5/20 patients and brain contusions in 4/20 patients. Nonoperative management was utilized in 6/20 patients. Procedural approaches included craniotomy (11/20), emergency burr hole (4), endoscopy (2), and ventriculostomy (2). Most patients responded to initial treatment (19/20). One early and one delayed death were reported. Traumatic TP is rare, tends to be associated with severe craniofacial injuries, and can occur following both blunt and penetrating injury. Early recognition and high index of clinical suspicion are important. Appropriate treatment results in improvement in vast majority of cases. CT scan is the diagnostic modality of choice for TP.Republished with permission from:Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery II PR, Papadimos TJ, Stawicki SPA. Traumatic tension pneumocephalus: Two cases and comprehensive review of literature. OPUS 12 Scientist 2010;4(1):6-11.

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Section: Discussionmentioning

confidence: 85%

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Pillai

Sharma

MacKenzie

et al. 2017

Int J Crit Illn Inj Sci

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“…An attempt was made to explain this effect based on the volume of gas, with one author using the value of 65 mL of air. [ 17 ] Others believe that about 25 mL of air can cause TP. [ 2 ] However, this method is hindered by the inherent difficulties in volume estimation in all CT scans.…”

Section: Discussionmentioning

confidence: 99%

Review of the management of pneumocephalus

et al. 2015

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Background:Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the “Mount Fuji sign.” In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition.Case Description:A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.Conclusion:The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

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“…It is an acute condition that can sometimes cause serious neurological complications, and therefore an accurate diagnosis and prompt treatment are required [ 2 ]. It has been reported that tension pneumocephalus in the subdural space with a volume of air over 65 cm 3 , as seen in the patient reported in this case study, occurs in under 8% of patients with basilar skull fractures including fracture of the sinuses [ 6 7 ]. On CT images, tension pneumocephalus in the subdural space typically shows a tented configuration in which trapped air located in the front compresses both frontal lobes ( Fig.…”

Section: Discussionmentioning

confidence: 89%

Communicating Hydrocephalus Onset Following a Traumatic Tension Pneumocephalus

Lee

Ahn

Eom

2016

Arch Craniofac Surg

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The entrapment of intracranial air from the check valve system results in a tension pneumocephalus. It should be distinguished from simple pneumocephalus because they are intracranial space-occupying masses that can threaten life. Communicating hydrocephalus is a serious and frequent complication of post-traumatic head injury. Head injury is one of the most common causes in etiopathogenesis of communicating hydrocephalus. Here, we describe a case of a 65-year-old man who developed communicating hydrocephalus after a post-traumatic tension pneumocephalus. To the best of our knowledge, this is the first reported case of communicating hydrocephalus developed after a post-traumatic tension pneumocephalus. Although the exact pathogenic mechanisms underlying the cascade following trauma remain unclear, communicating hydrocephalus after a tension pneumocephalus could be considered a possible complication.

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Subdural Tension Pneumocephalus Following Surgery

Cited by 34 publications

References 0 publications

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Traumatic tension pneumocephalus – Two cases and comprehensive review of literature

Review of the management of pneumocephalus

Communicating Hydrocephalus Onset Following a Traumatic Tension Pneumocephalus

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