Tension pneumoventricle after resection of a fourth ventricle choroid plexus papilloma: An unusual postoperative complication

Abstract

Background:Pneumocephalus is defined as the presence of air within the intracranial vault. A common complication of head trauma and surgery, pneumocephalus is usually related to ventricular shunts, craniotomies, and surgery in the sitting position. Tension (symptomatic) pneumoventricle is a rare entity associated with significant clinical morbidity.Case Description:We report an unusual case of a 15-year-old girl with tension pneumoventricle developed shortly after removal of a choroid plexus papilloma of the fourth ventricle by a midline suboccipital approach while in the sitting position.Conclusion:The presence of a cerebrospinal fluid (CSF) diversion system that causes a decrease in intracranial pressure and the existence of a craniodural defect with or without an obvious CSF leak may be the cause of tension pneumoventricule. According to our present understanding, this is the first report of this peculiar complication of fourth ventricular surgery. We discuss clinical manifestations, surgical management, contributing factors, and mechanisms involved in the pathogenesis of tension pneumoventricle.

Pneumocephalus and Neurologic Deficit Due to Neck Stab Wound in a Twenty Nine-Year-Old Man

“…A small amount of the air is asymptomatic and misleading and resolves spontaneously after a few days, however, high inspired oxygen concentration can accelerated its absorption (11). Surgical intervention in order to repair dura mater defects should only be performed when there is neurological deficit, persistent CSF leakage or infection (1,12). Simple X ray, CT scan or MRI diagnose the air in spinal and cranial space.…”