Tension Pneumocephalus from Positive Pressure Ventilation Following Endoscopic Skull Base Surgery: Case Series and an Institutional Protocol for the Management of Postoperative Respiratory Distress

Castle-Kirszbaum, Mendel; Wang, Yi Yuen; King, James; Uren, Brent; Kim, Martin; Danks, R. Andrew; Goldschlager, Tony

doi:10.1016/j.wneu.2020.06.079

Cited by 10 publications

(16 citation statements)

References 19 publications

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“…TP following skull base surgery is a rare complication, previously reported to have only been reported in 33 cases in the literature, [1][2][3]6,7,14,15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] including this case (Table 1). Iatrogenic injury has been reported as a cause of TP during skull base surgery.…”

Section: Discussion/conclusionmentioning

confidence: 92%

“…These include the placement of a lumbar or ventricular drain, osteoradionecrosis, single layer closure of the defect, and positive pressure ventilation. [9][10][11][12][13][14][15][16][17] Placement of lumbar drains perioperatively has previously been thought of as controversial. Lumbar drains are placed to minimize the risk of CSF leak in surgery involving the posterior cranial fossa as well as in anterior skull base surgery.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Polster et al 33 Endoscopic sinus surgery Recovery Iqbal/ et al 34 Transphenoidal resection pituitary macroadenoma Recovery Biju et al 2 Bifrontal craniotomy and transnasal endoscopic surgery Recovery Castle-Kirszbaum et al 15 Endoscopic It is not possible to definitively determine the mechanism by which tension pneumocephalus developed in this patient. While it is likely that an inverted soda bottle mechanism contributed to this patient's presentation, it could also have been due to a flap-valve mechanism or a combination of the 2 as they are not mutually exclusive.…”

Section: Recoverymentioning

confidence: 95%

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Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Whisonant

Shahriari

Kuhn

et al. 2021

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Tension pneumocephalus (TP) is a rare complication following skull base surgery with potentially deadly consequences if not recognized and treated quickly. Characterized by the presence of air with a pressure gradient inside of the intracranial vault capable of causing mass effect, TP can result in altered mental status, seizures, or even death. We present the case of a 52-year-old male with recurrent hemangiopericytoma who underwent tumor resection and reconstruction complicated by tension pneumocephalus. It was determined to be caused by a failure of the drain site closure in the setting of a lumbar drain, thus resulting in an “inverted soda bottle” effect leading to TP. We review the reported cases of TP in skull base surgery and highlight the importance of ensuring drain site closure in order to prevent the development of tension pneumocephalus after skull base surgery.

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Section: Discussion/conclusionmentioning

confidence: 92%

Section: Discussion/conclusionmentioning

confidence: 99%

Section: Recoverymentioning

confidence: 95%

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Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Whisonant

Shahriari

Kuhn

et al. 2021

FACE

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“…33 During the study period we developed and introduced a tension pneumocephalus protocol that has reduced the incidence of this life-threatening complication. 34 Loss of olfaction is debilitating and has substantial impact on QOL. 35 Taste is inextricably linked to smell, and combined deficits may further impact well-being.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes and longitudinal quality of life after endoscopic endonasal surgery for anterior skull base meningioma

Castle-Kirszbaum

Kam

Dixon

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The objective of this study was to establish the effect of endoscopic endonasal surgery on longitudinal quality of life (QOL) in patients with anterior skull base meningioma. METHODS A prospectively collected cohort of consecutively operated anterior skull base meningiomas was analyzed. All cases were performed using the endoscopic endonasal approach (EEA). Sinonasal-specific and overall QOL were measured using the 22-Item Sinonasal Outcome Test and the Anterior Skull Base Questionnaire longitudinally (at 3 weeks, 6 weeks, and 3, 6, and 12 months) across the first postoperative year. The relationship between surgical and QOL outcomes to clinical and radiological characteristics was analyzed using multivariate regression. RESULTS Fifty cases were available, with a mean age of 61.5 years and female predominance (74.0%). Visual dysfunction and headache were the most common presenting symptoms, and tumors commonly took origin from the planum (46.0%), tuberculum (44.0%), and olfactory groove (24.0%). Median tumor volume was 4.6 cm3. Visual improvement was noted in 73.1% of cases with preoperative field deficits, while nonimprovement was associated with greater tumor height (p = 0.04). Gross-total resection was not possible in patients with 360° vessel encasement and high-grade cavernous sinus extension with ophthalmoplegia. Postoperative diabetes insipidus was observed only in cases with suprasellar extension. Sinonasal-specific QOL worsened transiently after surgery but returned to baseline levels after 3 weeks. Olfaction and taste scores returned to preoperative baseline scores within the year. Overall QOL at presentation was worse in those with larger tumors (p = 0.04) and visual failure (p = 0.04) and better in those presenting with headache (p = 0.04). Transient worsening of QOL was seen in the first 3 weeks, which returned to baseline by 6 weeks, and then improved to above preoperative levels at 6 months and beyond. Worse QOL at baseline (p = 0.01) and visual improvement (p = 0.01) predicted QOL improvement after surgery. CONCLUSIONS Longitudinal QOL in anterior skull base meningioma has been examined for the first time. Endoscopic endonasal surgery improves overall QOL after a transient 3-week worsening due to the sinonasal morbidity of the approach. Visual function is intimately tied to QOL, with worse vision associated with worse preoperative QOL, and QOL improving in parallel with visual restoration after surgery. The EEA is associated with better visual outcomes and should be the preferred approach in accessible tumors.

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“…El término "neumoencéfalo a tensión" fue descrito en 1962 por Ectors, Kessler y Stern 11 . Es relevante tener en cuenta las manifestaciones clínicas y los hallazgos imagenológicos de un NT para un diagnóstico y manejo precoz, al ser una patología potencialmente grave que requiere una descompresión rápida para prevenir la herniación y muerte 1,2,12,13 .…”

Section: Introductionunclassified

Neumoencéfalo, una revisión de literatura

G.¹,

et al. 2023

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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Tension Pneumocephalus from Positive Pressure Ventilation Following Endoscopic Skull Base Surgery: Case Series and an Institutional Protocol for the Management of Postoperative Respiratory Distress

Cited by 10 publications

References 19 publications

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Surgical outcomes and longitudinal quality of life after endoscopic endonasal surgery for anterior skull base meningioma

Neumoencéfalo, una revisión de literatura

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