Tension Pneumocephalus as a Complication of Lumbar Drainage for Cerebral Aneurysm Surgery -Case Report-

Abstract

A 66-year-old man developed tension pneumocephalus after failed lumbar drainage before clipping surgery for a ruptured anterior communicating artery aneurysm. After puncture with a Tuohy needle, the spinal catheter could not be inserted into the spinal dura, so surgery proceeded without the catheter placement. The patient's neurological status deteriorated suddenly into coma within 15 hours after uneventful clipping of the aneurysm. Computed tomography revealed tension pneumocephalus with marked brain shift. Intracranial hypotension was probably caused by continuous cerebrospinal fluid leakage from the iatrogenic spinal dural tear, resulting in air entry and accumulation into the cranium from an unidentified opening of the cranial dura. The patient was immediately treated with autologous epidural blood patch administration in the lumbar spine, followed by reopening of the craniotomy incision and flap to evacuate the accumulated air. The patient made a quick and uneventful neurological recovery after the rescue procedure.

Flow-regulated external lumbar drain: applications and complications

“…A flow-regulated versus a pressure-regulated external drainage may have a lower incidence of complications involved with over-drainage and abrupt decompression, such as nausea, vomiting, diplopia, alteration of consciousness and tension pneumocephalus [4][5][6][7]. It has also been proposed that a continuous flow may help maintain the system patency [7] with a high viscosity CSF, as blood clots, protein and cellular debris are not permitted to settle inside the drain tubing.…”

Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

“…The main risk factors are (i) replacement of chronic subdural hematoma with oxygen,[1] (ii) position and duration of the surgery,[1617] (iii) intraoperative administration of mannitol or frusemide,[71617] (iv) nitrous oxide anesthesia,[9] (v) gross hydrocephalus,[13] (vi) functioning ventriculo-peritoneal shunt,[1317] (vii) lumbo-peritoneal drainage[12] and (viii) drain insertion after the hematoma cavity is irrigated. [11]…”

Tension pneumocephalus following suboccipital sitting craniotomy in the pediatric population

“…However, TP is not associated solely with sitting position. There are anecdotal reports on TP developing after prone craniotomy [6], lumbar drainage for aneurysm surgery in supine position [7], conservative treatment of rhinorrhea [8], scuba diving [9], traffic accident [10], etc. A role of nitrous oxide in the development of TP has also been postulated [11], as well as that of hyperbaric oxygen therapy [12].…”