Unexpected prominent tension pneumosella five years after endoscopic endonasal transsphenoidal surgery

Matsuda, Tatsuma; Horiguchi, Kentaro; Higuchi, Yoshinori; Hanazawa, Toyoyuki; Okamoto, Yoshitaka; Iwadate, Yasuo

doi:10.1002/lary.27060

Cited by 7 publications

(7 citation statements)

References 8 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%

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Whisonant

Shahriari

Kuhn

et al. 2021

FACE

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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%

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Whisonant

Shahriari

Kuhn

et al. 2021

FACE

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“…Eighteen articles were identified using the search strategy outlined above in the study design and literature review. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The earliest report from this search was a single case report published in 1994. 3 Including the four cases from our institutions described above, a total of 26 cases were included in the review (Table 1) For the treatment of TP, endoscopic multilayer closure of the skull base defect was performed in 13 patients, cranial burr hole surgery in two, cranial burr hole surgery and endoscopic multilayer closure of the skull base defect in five, and bifrontal craniotomy to repair the defect in the skull base in two patients.…”

Section: Resultsmentioning

confidence: 99%

“…Surprisingly, Matsuda et al reported that one patient unexpectedly incurred prominent TP 5 years after endoscopic endonasal trans-sphenoidal surgery for pituitary adenoma. 12 Therefore, it is crucial that otolaryngologists and neurosurgeons understand that TP may also occur many years after endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

<p>Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review</p>

Liu

et al. 2020

TCRM

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Tension pneumocephalus (TP) caused by endoscopic endonasal surgery is a serious complication. We report four cases of TP caused by endoscopic surgery and review other cases in the literature, with special attention devoted to symptoms, imaging features, and therapeutic approaches. Methods: A retrospective chart review of patients who experienced TP caused by endoscopic surgery in our institution between 2015 and 2018 was performed. Additionally, the MEDLINE database was searched for all case series or reports of TP caused by endoscopic surgery. Results: Eighteen articles were identified for review, including four cases from the authors' institution; ultimately, 26 cases were included in the present study. The main symptoms of TP were headache and a change in mental status. Cerebrospinal fluid (CSF) leakage was reported in 21 of the 26 patients (80.8%). Eight of the 26 patients (30.8%) presented with the "Mount Fuji sign" imaging feature. Twenty-four patients were treated with surgical intervention for TP (endoscopic multilayer closure of skull base defect, cranial burr hole, or bifrontal craniotomy). In addition, the present study is the first to report two patients with TP who were successfully treated conservatively. Conclusion: The therapeutic method for treating TP should depend on the degree of the mass effect and clinical symptoms. When patients with TP present with obvious symptoms of CSF leakage and intracranial hypertension, urgent surgical multilayer repair of the skull base defects and/or release of the intracranial pressure are keys to treating these patients. However, conservative treatment under close observation is also feasible when the related symptoms are not overtly obvious.

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“…Avoidance of postoperative diaphragmatic defects was found to be of great significance in avoiding complications [15]. In addition, even if immediate postoperative pneumocephalus can be avoided by simple repair of diaphragmatic defects, some authors advocate the need for rigid reconstruction with septal cartilage or a titanium plate to prevent invagination of the sphenoid mucosa [23,24]. Pneumocephalus can develop in the sella floor; there is a report of tension pneumosella occurring five years after endoscopic endonasal transsphenoidal surgery [24].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, even if immediate postoperative pneumocephalus can be avoided by simple repair of diaphragmatic defects, some authors advocate the need for rigid reconstruction with septal cartilage or a titanium plate to prevent invagination of the sphenoid mucosa [23,24]. Pneumocephalus can develop in the sella floor; there is a report of tension pneumosella occurring five years after endoscopic endonasal transsphenoidal surgery [24]. Consequently, CSF leaks with persistent PNC could bear greater risks than simple CSF leaks [13,19].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

Gâta

Toader²,

Trombitaș

et al. 2020

JCM

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Background: Cerebrospinal (CSF) fluid leaks with associated pneumocephalus (PNC) represent a condition bearing serious risks for the patient, with little data available in the literature. Reported success rates of endoscopic skull base repair are lower when PNC is associated than in the case of simple CSF leaks. The present study represents an analysis of our experience with endoscopic management of this condition. Methods: Records of patients with pneumocephalus and associated CSF leaks, who underwent endoscopic skull base repair, were reviewed. Demographics, history, etiology of PNC, size of defect, surgical approach, reconstruction technique and complications were evaluated. Results: Twenty patients with CSF leaks and PNC underwent endonasal repair by the senior author between 2005 and 2019. Defect size was larger than 15 mm in all cases. All patients presented either worsening of PNC under conservative treatment or tension PNC. First-attempt closure of the defect was successful in all patients (100%), with resolution of the pneumocephalus. One patient developed a synechia in the proximity of the frontal ostium, as a postoperative complication. The mean follow-up was 39 months (range: 15–94 months). Conclusion: The present study represents a proposed argument for earlier endoscopic endonasal treatment in patients presenting CSF leaks and pneumocephalus.

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Unexpected prominent tension pneumosella five years after endoscopic endonasal transsphenoidal surgery

Cited by 7 publications

References 8 publications

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

<p>Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review</p>

Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

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